Citation Nr: 18152067 Decision Date: 11/20/18 Archive Date: 11/20/18 DOCKET NO. 16-43 132 DATE: November 20, 2018 ORDER Entitlement to service connection for glaucoma, to include as due to exposure to contaminated water at Camp Lejeune is denied. Entitlement to service connection for a heart disorder, to include as due to exposure to contaminated water at Camp Lejeune is denied. Entitlement to service connection for prostate cancer, to include as due to exposure to contaminated water at Camp Lejeune is denied. is denied. Entitlement to service connection for posttraumatic stress disorder (PTSD) is denied. Entitlement to an initial evaluation in excess of 70 percent for Major Depressive Disorder (MDD) is denied. REMANDED Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. FINDINGS OF FACT 1. Glaucoma was not manifest in service, or within one year of separation, and is not related to service. 2. A heart disorder did not manifest in service, or within one year of separation, and is not related to service. 3. Prostate cancer did not manifest in service, or within one year of separation, and is not related to service. 4. The Veteran does not have a current diagnosis of PTSD in accordance with DSM criteria. 5. Major Depressive Disorder is manifest by symptoms such as anxiety, depressed mood, chronic sleep impairment, impaired judgment, difficulty adapting to stressful circumstances, and an inability to establish and maintain effective relationships, resulting in occupational and social impairment with deficiencies in most areas. CONCLUSIONS OF LAW 1. Glaucoma was not incurred in or aggravated by service and an organic disease of the nervous system may not be presumed to have been incurred therein. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1137 (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2017). 2. A heart disorder was not incurred in or aggravated by service and cardiovascular disease may not be presumed to have been incurred therein. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1137 (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2017). 3. Prostate cancer was not incurred in or aggravated by service and may not be presumed to have been incurred therein. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1137 (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2017). 4. PTSD was not incurred in or aggravated by service. 38 U.S.C. § 1110 (2012); 38 C.F.R. §§ 3.303, 3.304 (2017). 5. The criteria for an initial evaluation in excess of 70 percent for Major Depressive Disorder have not been met. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 3.321, 4.1, 4.7, 4.125, 4.126, 4.130, Diagnostic Code 9434 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from November 1969 to January 1973 and November 1974 to March 1975. The Board has determined that a claim for entitlement to a TDIU has been raised by the record. Rice v. Shinseki, 22 Vet. App. 447 (2009). Service Connection Veterans are entitled to compensation if they develop a disability “resulting from personal injury suffered or disease contracted in line of duty, or for aggravation of a preexisting injury suffered or disease contracted in line of duty.” 38 U.S.C. § 1110 (wartime service), 1131 (peacetime service). To establish entitlement to service-connected compensation benefits, a Veteran must show: “(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service -the so-called ‘nexus’ requirement.” Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service establishes that the disability was incurred in service. 38 C.F.R. § 3.303 (d). The determination as to whether these requirements are met is based on an analysis of all the evidence of record and the evaluation of its credibility and probative value. See Baldwin v. West, 13 Vet. App. 1, 8 (1999). Certain diseases are identified as “chronic” under 38 U.S.C. § 1101 and 38 C.F.R. § 3.309 (a). These diseases include cardiovascular disease, organic diseases of the nervous system (glaucoma), and malignant tumors (prostate cancer). VA treatment records indicate that the Veteran has been diagnosed with coronary artery disease, ischemic heart disease, glaucoma, and prostate cancer. “For the showing of chronic disease in service there is required 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 disease identity is established (leprosy, tuberculosis, multiple sclerosis, etc.), there is no requirement of evidentiary showing of continuity. Continuity of symptomatology is required only where the condition noted during service (or in the presumptive period) is not, in fact, shown to be chronic or where the diagnosis of chronicity may be legitimately questioned. When the fact of chronicity in service is not adequately supported, then a showing of continuity after discharge is required to support the claim.” 38 C.F.R. § 3.303 (b). Specific to the Veteran’s compensation claims for glaucoma, a heart disorder and prostate cancer, he asserts that they are secondary to his exposure to contaminated water while stationed at Camp Lejeune. Effective March 14, 2017, 38 C.F.R. §§ 3.307 and 3.309 were amended to add eight diseases to the list of diseases associated with contaminants present in the water supply at U.S. Marine Corps Base Camp Lejeune, North Carolina, from August 1, 1953, to December 31, 1987. The amendments apply to claims received by VA on or after January 13, 2017, and claims pending before VA on that date. Amended 38 C.F.R. §§ 3.307 and 3.309 establish presumptive service connection for Veterans, former reservists, and former National Guard members who served at Camp Lejeune for no less than 30 days (either consecutive or nonconsecutive) during this period, and who have been diagnosed with any of the following eight diseases: adult leukemia; aplastic anemia and other myelodysplastic syndromes; bladder cancer; kidney cancer; liver cancer; multiple myeloma; non-Hodgkin’s lymphoma; and Parkinson’s disease. In addition, the amendments establish a presumption that these individuals were disabled during the relevant period of service, thus establishing active military service for benefit purposes. This amendment implements a decision by the Secretary of Veterans Affairs that service connection on a presumptive basis is warranted for claimants who served at Camp Lejeune and later develop the certain diseases listed above. Personnel records confirm that the Veteran was stationed at Camp Lejeune for the required duration during the period delineated under 38 C.F.R. § 3.307. However, as glaucoma, heart disorders, and prostate cancer are not listed under 38 C.F.R. § 3.309, they are not presumed to be related to his exposure to contaminated water at Camp Lejeune during his service. Nevertheless, exposure to contaminated water is conceded. The absence of a disease from the presumptive list does not preclude a veteran from otherwise proving that his disability resulted from exposure to contaminated water at Camp Lejeune. See Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994). Accordingly, the Board will still consider whether entitlement to service connection can be granted on any other basis. The central issue in this case is whether the Veteran’s glaucoma, heart disorders, and prostate cancer are etiologically related to that exposure. 1. Entitlement to service connection for glaucoma, to include as due to exposure to contaminated water at Camp Lejeune 2. Entitlement to service connection for a heart disorder, to include as due to exposure to contaminated water at Camp Lejeune The Veteran’s primary assertion is that his glaucoma and heart disorders are due to the exposure to water at Camp Lejeune. Service treatment records do not document any relevant complaints, symptoms, treatment, or diagnoses. Clinical evaluation at a January 1973 examination upon separation from the first period of service revealed normal eyes and heart. A November 1974 separation examination from the second period of service also revealed normal eyes and heart. In an accompanying Report of Medical History, the Veteran denied any eye trouble, heart trouble, or any other relevant symptoms. The Veteran has not submitted any medical evidence showing a link between his glaucoma and heart disorders and his active service, to include exposure to contaminated water. In adjudicating a claim, the Board is charged with the duty to assess the credibility and weight given to evidence. See Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997). Competency of evidence differs from weight and credibility. The former is a legal concept determining whether testimony may be heard and considered by the trier of fact, while the latter is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997). The Board has also considered the lay statements of record, to include the Veteran’s previously referenced assertions. With respect to the Veteran’s report that he has experienced a continuity of symptoms since service, he is competent to report his observations and relate what he was told by medical professionals. Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Of note, the Veteran has not indicated that a medical professional provided him with a diagnosis of glaucoma or a heart disorder during service or immediately thereafter. Id. However, the Veteran’s lay evidence of onset and continuity is directly contradicted by service treatment records, to include clinical evaluation revealing normal eyes and heart, and the Veteran’s specific denial of relevant symptoms upon separation from both periods of active service. The Board finds the contemporaneous medical records to be of greater probative value. In sum, there is no reliable evidence linking the Veteran’s glaucoma and heart disorders to service. The contemporaneous records establish that there were no documented manifestations of such disorders in service, the eyes and heart were physically normal upon separation, there were no manifestations of glaucoma or cardiovascular disease within one year of separation, and glaucoma and cardiovascular disease were first manifest many years after separation. The Board finds the contemporaneous records to be far more probative and credible than the Veteran’s report of onset, continuity, and treatment. Here, chronic disease (cardiovascular disease or organic disease of the nervous system) was not “noted” during service or within one year of separation within the meaning of section 3.303(b). Service treatment records do not show a combination of manifestations sufficient to identify the disease entities, and sufficient observation to establish chronicity at the time. The Veteran has provided nothing beyond his assertion that his glaucoma and heart disorders are related to exposure to contaminated water in service. However, treatment records indicate that the heart and eyes were normal at separation from both periods of active service, and the Veteran specifically denied any relevant symptoms. Furthermore, the evidence does not establish that cardiovascular disease or glaucoma were manifest within one year of separation. 38 C.F.R. §§ 3.307; 3.309. The evidence of record shows that glaucoma and cardiovascular disease were manifest many years after service. The Veteran was not shown to have glaucoma or a heart disorder, or any relevant chronic disorder in service and did not have characteristic manifestations of glaucoma or cardiovascular disease until multiple years after discharge. In essence, the evidence establishes that the eyes and heart were normal upon separation from service and the onset of cardiovascular disease and glaucoma occurred many years after service. The Board finds that the contemporaneous in-service and post-service treatment records are entitled to greater probative weight and credibility than the lay statements of the Veteran. The more probative evidence establishes that he did not have a glaucoma or a heart disorder during service or within one year of separation. Furthermore, the evidence establishes that the remote onset of glaucoma and a heart disorder is unrelated to service. The Board finds that the preponderance of the evidence is against the claim and the claim must be denied. Under 38 U.S.C. § 5103A (d), VA must provide a medical examination and/or obtain a medical opinion when there is: (1) competent evidence that the veteran has a current disability (or persistent or recurrent symptoms of a disability); (2) evidence establishing that an event, injury or disease occurred in service; (3) an indication that the current disability or symptoms may be associated with service; and (4) there is not sufficient medical evidence to make a decision on the claim. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). A VA medical opinion has not been obtained for the Veteran’s claimed glaucoma and heart disorder. The Board, however, finds that no VA opinion is necessary for these claims. As noted, there is no evidence establishing that an event, injury or disease occurred in service relevant to these disorders. Relevant examinations were normal throughout service and upon separation, and the Veteran specifically denied relevant symptoms. Additionally, there is no indication that the currently diagnosed glaucoma and heart disorders may be associated with service and there is sufficient medical evidence to make a decision on the claim. As such, pursuant to McLendon, a VA opinion is not warranted for this claim. Furthermore, the Veteran has provided no information with respect to his claimed conditions beyond the assertion that they are related to exposure to contaminated water, despite being afforded the opportunity to do so. See Wood v. Derwinski, 1 Vet. App. 190, 193 (1991) (“The duty to assist is not always a one-way street. If a veteran wants help, he cannot passively wait for it in those circumstances where he may or should have information that is essential in obtaining the putative evidence”). 3. Entitlement to service connection for prostate cancer, to include as due to exposure to contaminated water at Camp Lejeune is denied. The Veteran’s primary assertion is that his prostate cancer is due to exposure to water at Camp Lejeune. Service treatment records do not document any relevant complaints, symptoms, treatment, or diagnoses. Clinical evaluation at a January 1973 examination upon separation from the first period of service revealed a normal genitourinary system. A November 1974 separation examination from the second period of service also documented a normal genitourinary system. In an accompanying Report of Medical History, the Veteran denied any relevant symptoms. In a November 2012 VA medical opinion, the examiner concluded that there was no plausible connection between the Veteran’s prostate cancer and his exposure to contaminated water. The examiner cites medical literature and the Veteran’s risk factors specific to prostate cancer, including over 45 years of smoking. In a June 2016 VA medical opinion, the examiner concluded that the Veteran’s prostate cancer is less likely than not related to his in-service exposure. The examiner referenced treatment records, highlighted that the Veteran’s diagnosis of prostate cancer was made approximately 38 years after separation, and referenced the Veteran’s risk factors for prostate cancer, including 45 years of smoking, being mildly overweight, and age. The examiner also cited medical literature. The probative value of a medical opinion primarily comes from its reasoning; threshold considerations are whether a person opining is suitably qualified and sufficiently informed. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). In this case, the Board accepts the November 2012 and June 2016 VA medical opinions that the Veteran’s prostate cancer is less likely than not related to his exposure at Camp Lejeune as highly probative medical evidence on this point. The Board notes that the examiners rendered the opinions after thoroughly reviewing the claims file and relevant medical records. The examiners noted the Veteran’s pertinent history and provided a reasoned analysis of the case. See Hernandez-Toyens v. West, 11 Vet. App. 379, 383 (1998); Gabrielson v. Brown, 7 Vet. App. 36, 40 (1994) (the probative value of a physician’s opinion depends in part on the reasoning employed by the physician and whether or not (or the extent to which) he reviewed prior clinical records and other evidence). The Board has considered the Veteran’s lay assertions that his prostate cancer was caused by contaminated water supplies at Camp Lejeune during service. However, these assertions are inconsistent with the medical examiners’ findings supported by medical and scientific literature as well as the examiners’ medical expertise. Additionally, the examiners provided credible causal explanations for the cause of the Veteran’s prostate cancer, e.g. aging, weight, and smoking. The Board accords great weight to the VA examiners’ opinions, as the examiners were informed by the Veteran’s service and post-service medical records and pertinent medical literature. Thus, the Board finds the medical evidence to be more probative than the Veteran’s assertions. As a result, the Board finds that the weight of the evidence shows that the Veteran’s prostate cancer is not related to his exposure to contaminated water at Camp Lejeune. Beyond the assertion of exposure to contaminated water, there is no reliable evidence linking the Veteran’s prostate cancer to service. As noted, service treatment records do not document any relevant symptoms, complaints, treatment, diagnoses, or other notations, and the relevant systems were normal upon separation. Prostate cancer was first identified in 2011 and the VA medical opinions of record indicate that the Veteran’s prostate cancer is more likely related to a variety of risk factors that are not associated with service (aging, weight, smoking). Nothing in the record suggests a history of prostate cancer dating back to service. As such, the contemporaneous records establish that prostate cancer was first manifest many years after separation. We find the contemporaneous records to be far more probative and credible than any assertion of continuity and treatment. The Board again notes that the Veteran’s sole assertion has been that prostate cancer is related to exposure to contaminated water at Camp Lejeune, and he has not provided an alternative theory. Here, prostate cancer was not “noted” during service within the meaning of section 3.303(b). Service treatment records do not show a combination of manifestations sufficient to identify the disease entities, and sufficient observation to establish chronicity at the time. Furthermore, the evidence does not establish that it was manifest to a compensable degree within one year of separation. 38 C.F.R. §§ 3.307; 3.309. There is no showing of continuity and the Veteran has not asserted as much. The Veteran was not shown to have prostate cancer in service and did not have characteristic manifestations until many years after discharge. The more probative evidence establishes that he did not have prostate cancer during service or within one year of separation. Furthermore, the evidence establishes that the remote onset of prostate cancer is unrelated to service, to include exposure to contaminated water. The Board finds that the preponderance of the evidence is against the claim and it must be denied. 4. Entitlement to service connection for posttraumatic stress disorder (PTSD) There are particular requirements for establishing service connection for PTSD in 38 C.F.R. § 3.304 (f) that are separate from those for establishing service connection generally. Arzio v. Shinseki, 602 F.3d 1343, 1347 (Fed. Cir. 2010). Service connection for PTSD requires medical evidence diagnosing the condition in accordance with 38 C.F.R. § 4.125 (a); a link, established by medical evidence, between current symptoms and an in-service stressor; and credible supporting evidence that the claimed in-service stressor occurred. 38 C.F.R. § 3.304 (f) and 38 C.F.R. § 4.125 (requiring PTSD diagnoses to conform to the DSM-IV/V). The Veteran’s claimed stressors are specific to in-service punishment for missing a meeting and witnessing a fellow recruit being yelled at. To the extent that the provisions of 38 C.F.R. § 3.304 (f)(5) are applicable, for a PTSD claim that is based on personal assault in service, evidence from sources other than the Veteran’s records may corroborate the Veteran’s account of the stressor incident. Examples of such evidence include, but are not limited to: records from law enforcement authorities, mental health counseling centers, hospitals or physicians; and statements from family members, roommates, fellow service members, or clergy. Mengassi v. Shinseki, 638 F.3d 1379 (Fed. Cir. 2011); 38 C.F.R. § 3.304 (f)(5). VA is required to give due consideration to all pertinent medical and lay evidence in evaluating a claim for disability benefits. 38 U.S.C. § 1154 (a). 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, supra. If the evidence is competent, the Board must then determine if the evidence is credible, or worthy of belief. Barr v. Nicholson, 21 Vet. App. 303, 308 (2007). After determining the competency and credibility of evidence, the Board must then weigh its probative value. In this regard, 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, 511-12 (1995). Congress has specifically limited entitlement to service connection for disease or injury to cases where such incidents have resulted in disability. 38 U.S.C. § 1110. See also McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). Accordingly, where competent medical evidence indicates that the appellant does not have the disability for which service connection is sought, there can be no valid claim for service connection for the disability. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). A review of VA examinations and treatment records during the period on appeal (PTSD claim dated December 21, 2011) does not reveal a diagnosis of PTSD in accordance with the pertinent regulations. 38 C.F.R. §§ 3.304 (f); 4.125 (a). VA treatment records in May 2013 note that the DSM criteria for PTSD were not met. Relevant psychiatric examinations during the period on appeal do not make a diagnosis of PTSD consistent with the relevant criteria. The Board notes that at a May 2013 VA examination, a history of PTSD is recorded. VA treatment records similarly document PTSD in the problem list. The May 2013 examination report suggests that the Veteran’s PTSD stems from his abusive childhood. The examiner similarly concludes that the reported history of PTSD is not related to service. Despite this reported history of PTSD, a diagnosis consistent with the DSM has not been made during the period on appeal. Here, the medical evidence suggests a possible history of PTSD, however, it clearly does not show a diagnosis in accordance with the relevant provisions during the period on appeal. In the absence of a disability, compensation may not be awarded. In the absence of evidence of PTSD, there can be no grant of service connection under the law. See Brammer, supra. In reaching this finding, the Board notes that the Veteran is service-connected for Major Depressive Disorder and the evidence does not suggest the presence of another psychiatric disorder. Clemmons v. West, 206 F.3d 1401, 1403 (Fed. Cir. 2000). To the extent that the Veteran does have PTSD, or ever did have PTSD, it is clear from the record that it is related to pre-service events. There is no indication that PTSD was aggravated by active service. 5. Entitlement to an initial evaluation in excess of 70 percent for Major Depressive Disorder (MDD) Disability evaluations are determined by evaluating the extent to which a veteran’s service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the Schedule for Rating Disabilities. The percentage ratings represent as far as can practicably be determined the average impairment in earning capacity resulting from such diseases and injuries and the residual conditions in civilian occupations. Generally, the degree of disabilities specified are considered adequate to compensate for considerable loss of working time from exacerbation or illness proportionate to the severity of the several grades of disability. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities and the criteria for specific ratings. If two disability evaluations are potentially applicable, the higher evaluation will be assigned to the disability picture that more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Any reasonable doubt regarding the degree of disability will be resolved in favor of a veteran. 38 C.F.R. § 4.3. Separate evaluations may be assigned for separate periods of time based on the facts found. In other words, the evaluations may be staged. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Here, the Board has determined that the current uniform evaluation is appropriate. The Veteran’s Major Depressive Disorder (MDD) is assigned an initial 70 percent evaluation under Diagnostic Code 9434, effective December 28, 2011. The Veteran has challenged the initial evaluation. Diagnostic Code 9434 pertains specifically to the primary diagnosed disability in the Veteran’s case (MDD). In any event, with the exception of eating disorders, all mental disorders including MDD are rated under the same criteria in the rating schedule. Therefore, rating under another diagnostic code would not produce a different result. Moreover, the Veteran has not requested that another diagnostic code be used. Accordingly, the Board concludes that the Veteran is appropriately rated under Diagnostic Code 9434. The criteria for a 70 percent rating are as follows: 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); inability to establish and maintain effective relationships. The criteria for a 100 percent rating are as follows: 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. 38 C.F.R. § 4.130, Diagnostic Code 9434. The “such symptoms as” language of the diagnostic codes for mental disorders in 38 C.F.R. § 4.130 means “for example” and does not represent an exhaustive list of symptoms that must be found before granting the rating of that category. See Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). However, as the Court also pointed out in that case, “[w]ithout those examples, differentiating a 30% evaluation from a 50% evaluation would be extremely ambiguous.” Id. The Court went on to state that the list of examples “provides guidance as to the severity of symptoms contemplated for each rating.” Id. Accordingly, while each of the examples needs not be proven in any one case, the particular symptoms must be analyzed in light of those given examples. Put another way, the severity represented by those examples may not be ignored. Effective August 4, 2014, VA amended the portion of the Rating Schedule dealing with mental disorders and its adjudication regulations that define the term “psychosis” to remove outdated references to the DSM-IV and replace them with references to the recently updated Fifth Edition (DSM-5). See 79 Fed. Reg. 149, 45094. The provisions of the interim final rule apply to all applications for benefits that are received by VA or that were pending before the AOJ on or after August 4, 2014. Id. 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. See 80 Fed. Reg. 53, 14308 (March 19, 2015). The RO originally certified the Veteran’s appeal to the Board in September 2016. As a result, the DSM-5 applies. Thus, the Board will not use previously recorded GAF scores to determine the appropriate evaluation for the Veteran’s PTSD. Golden v. Shulkin, No. 16-1208, 2018 Vet. App. LEXIS 202 (Feb. 23, 2018) (“the Board errs when it uses GAF scores to assign a psychiatric rating in cases where the DSM-5 applies.”) The medical evidence of record includes VA treatment records, VA examinations in April 2013 and May 2013, and a December 2013 Disability Benefits Questionnaire (DBQ) completed by a private examiner. After a review of the medical and lay evidence of record, an evaluation in excess of 70 percent is not warranted for any period on appeal. The evidence suggests that the Veteran’s symptomatology has more nearly approximated occupational and social impairment associated with a 70 percent disability rating for the entire period on appeal. In other words, the Board finds that the preponderance of the evidence is against an evaluation in excess of 70 percent. Neither the lay nor the medical evidence of record more nearly approximates the frequency, severity, or duration of psychiatric symptoms required for a 100 percent disability evaluation, nor does it demonstrate total occupational and social impairment. 38 C.F.R. §§ 4.7, 4.130, Diagnostic Code 9434. The Board has considered the VA treatment records, including all VA examination reports, private examinations, vocational reports, and lay statements regarding the impact of the Veteran’s MDD on his occupational and social impairment. During the entire period, the Veteran reported anxiety, depressed mood, chronic sleep impairment, impaired judgment, difficulty adapting to stress circumstances, and an inability to establish and maintain effective relationships, among other symptoms. It is documented that the Veteran has struggled with many social interactions. The Board finds that the degree to which the Veteran’s MDD inhibits his social relationships is consistent with the criteria of a 70 percent evaluation. He is able to maintain a good relationship with his girlfriend and her son. The evidence does not suggest that the Veteran is totally incapable of establishing and maintaining effective relationships. The medical and lay evidence does not show gross impairment in thought process or communication, persistent delusions or hallucinations, grossly inappropriate behavior, persistent danger of hurting self or other, disorientation, or significant memory loss. Furthermore, the objective medical conclusions of the VA examiners and the private examiner with respect to the severity of the Veteran’s occupational and social impairment, while not determinative, are not consistent with total occupational and social impairment. Rather, they are in agreement that it results in occupational and social impairment with deficiencies in most areas. The Board does note that the May 2013 VA examination and December 2013 DBQ document intermittent inability to perform activities of daily living. This is listed as criteria consistent with a 100 percent evaluation. However, having reviewed the entirety of the evidence, the Board finds that the overall level of disability does not exceed the criteria for a 70 percent rating. See Mauerhan, supra at 442. Thus, the Board finds that for this period the Veteran does not have total occupational and social impairment. He does have deficiencies in most areas, but the greater weight of evidence demonstrates that it is to a degree that is contemplated by the 70 percent rating assigned herein. Furthermore, even resolving any reasonable doubt in the Veteran’s favor, the Board finds that he does not meet the requirements for an evaluation greater than the now assigned 70 percent schedular rating. In other words, there is not total occupational and social impairment. REASONS FOR REMAND 1. Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. The Board notes that a VA Form 21-8940 is not of record. While the Veteran has submitted medical evidence indicating that he is unemployed, complete employment and income information is necessary. As a result, remand is necessary. The matter is REMANDED for the following action: 1. Send the Veteran appropriate notice regarding his claim for TDIU, to include a VA Form 21-8940. 2. Thereafter, conduct any other indicated development and then readjudicate the TDIU claim. If any benefit sought on appeal remains denied, furnish the Veteran a supplemental statement of the case and allow the appropriate time for response. Then, return the case to the Board. H. N. SCHWARTZ Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD W. R. Stephens, Counsel