Citation Nr: 18152337 Decision Date: 11/21/18 Archive Date: 11/21/18 DOCKET NO. 16-48 987 DATE: November 21, 2018 ORDER Entitlement to service connection for residuals of a dislocated right shoulder injury is granted. Entitlement to service connection for a dental condition, claimed as cracked teeth, is denied. Entitlement to an initial compensable rating for bilateral hearing loss disability is denied. Entitlement to an initial rating in excess of 30 percent for posttraumatic stress disorder (PTSD) disability is denied. REMANDED Entitlement to service connection for a neurologic condition, claimed as numbness and tingling, to include as due to exposure to herbicide agents is remanded. FINDINGS OF FACT 1. The competent evidence of records is at least in equipoise on whether the Veteran’s traumatic arthritis in his right shoulder is a result of injury incurred during his period of service. 2. The competent evidence of record does not show that the Veteran has been diagnosed with a dental disability for VA compensation purposes. 3. The Veteran’s hearing acuity demonstrated no more than Level II in his right ear and Level I in his left ear. 4. The Veteran’s service-connected PTSD has resulted in no more than 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. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for a residuals of dislocated right shoulder injury, identified as traumatic arthritis, have been met. 38 U.S.C. §§ 1110, 1131, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2018). 2. The criteria for entitlement to service connection for a dental disability for compensation purposes have not been met. 38 U.S.C. §§ 1110, 1131, 5107(b) (2012); 38 C.F.R. §§3.102, 3.303, 3.304, 3.381, 4.150, 17.161 (2018). 3. The criteria for entitlement to an initial compensable rating for bilateral hearing loss disability have not been met or approximated. 38 U.S.C. §§ 1155, 5103, 5107 (2012); 38 C.F.R. §§ 3.159, 4.1-4.7, 4.85, Diagnostic Code 6100 (2017). 4. [Deny] The criteria for entitlement to an initial rating in excess of 30 percent for posttraumatic stress disorder (PTSD) disability have not been met or approximated. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.7, 4.130, Diagnostic Code 9411 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from September 1968 to August 1971. These matters come before the Board of Veterans’ Appeals (Board) on appeal from an April 2015 rating decision by the Department of Veterans Affairs, Regional Office, located in Philadelphia, Pennsylvania (RO). The Board notes that a claim for service connection for a dental disability is also considered a claim for VA outpatient dental treatment. Mays v. Brown, 5 Vet. App. 302, 306 (1993). However, the Veteran has specifically stated that he does not desire VA dental outpatient treatment, he is only seeking VA compensation for his dental condition. See May 2015 statement in support of the case. Accordingly, the issue is limited to service connection for dental condition for VA compensation purposes, and a referral to the appropriate medical facility is not warranted. Service Connection Service connection will be granted if the evidence demonstrates that current disability resulted from a disease or injury incurred in active military service. 38 U.S.C. §§ 1110, 1131(2012); 38 C.F.R. § 3.303 (2018). Establishing service connection generally requires competent evidence of three things: (1) current disability; (2) in-service incurrence of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018). Consistent with this framework, service connection is warranted for a disease first diagnosed after discharge when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). 1. Entitlement to service connection for a residuals of dislocated right shoulder injury The Veteran contends that he has current residuals from a right shoulder dislocation injury that was incurred during his period of service. The Veteran reports that in 1969, he was involved in a helicopter crash in which he dislocated his right shoulder. He reports that a field medic manually manipulated his shoulder back into place. He denied any functional right shoulder problems during service or for years after his separation from service, but he reports that his right shoulder has progressively worsened in recent years. Service personnel records show that the Veteran’s military occupation was a helicopter gunner while he was stationed in the Republic of Vietnam from May 1969 to October 1969. He participated in the Tet 1969 Counteroffensive and he received the Aircraft Crewman’s Badge as well as Vietnam Service Medical and Vietnam Campaign Medical with two bars. The Board finds that the Veteran served in combat and the Veteran’s statements are consistent with the circumstances and conditions of his service as a helicopter gunner, to include involvement in a crash, while he served in Vietnam. Thus, the Veteran’s statements are sufficient to establish that he was involved in helicopter crash while serving in the Republic of Vietnam and he sustained injury to his right shoulder. The Board accepts the veracity of the Veteran’s statements. See 38 U.S.C. § 1154 (b) (2018). Section 1154(b) does not establish service connection for a combat veteran; rather, it aids him by relaxing the adjudicative evidentiary requirements for determining what happened in service. There must still be competent evidence tending to show a current disability and a relationship between that disability and those service events. A review of the service treatment records does not show evidence of a chronic right shoulder disorder, and the Veteran’s upper extremities were evaluated as normal on his September 1971 examination prior to separation. Further, the Veteran has not reported that he sought treatment for right shoulder problems until more recently. VA treatment records dated in June 2014 show that the Veteran presented to initiate his VA care. He complained of right shoulder pain, and he reported a history of dislocating his right shoulder during a helicopter crash in service. A November 2014 VA orthopedic consultation report shows that the Veteran report a history of dislocating his right shoulder during a helicopter crash while serving in the Republic of Vietnam in 1969 and he received manipulative reduction by a field medic. He further reported that he eventually had good shoulder function following the injury; however, in the recent years, his right shoulder problems have gradually worsened. Clinical examination revealed limitation of motion, and there was x-ray evidence of significant narrowing and other irregularities in the right shoulder joint. The Veteran was assessed with posttraumatic arthritis in the right shoulder. The VA orthopedic physician opined that the diagnostic evidence of significant degenerative changes in the Veteran’s right shoulder was almost certainly a result of his prior dislocation in service. Based on the above evidence, the Board concludes that the Veteran has a current diagnosis of traumatic arthritis in his right shoulder and that the evidence is at least evenly balanced as to whether this disability is a result of an in-service right shoulder dislocation injury. Again, the Board has accepted the Veteran’s reports of an in-service right shoulder dislocation injury was incurred during a helicopter crash, and the evidence of record demonstrates current diagnosis of traumatic arthritis in the right shoulder. In addition, a VA orthopedic physician has provided a medical opinion that links the Veteran’s current diagnosed right shoulder disorder to his in-service right shoulder dislocation injury. There is no medical opinion contrary to a conclusion that the current traumatic arthritis was result of injury incurred during service. Hence, the Board finds that the evidence is at least evenly balanced as to whether the evidence indicates that the current traumatic arthritis in the right shoulder is a result of an in-service right shoulder dislocation injury. In light of this evidence and as the reasonable doubt created by this relative equipoise in the evidence must be resolved in favor of the Veteran, entitlement to service connection for the currently diagnosed traumatic arthritis of the right shoulder is warranted. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. 2. Entitlement to service connection for a dental condition, claimed as cracked teeth The Veteran contends that he has a current dental disability, which should be compensable for VA purposes. The Veteran reports that in the same helicopter crash, he suffered cracked teeth which he eventually had replaced with dentures years after service. In a May 2015 statement, the Veteran specifically stated that he has his original dentures and he is not asking for additional dental treatment from VA. He believes he should be compensated for his dental disorder, claimed as cracked teeth, that was incurred during his period of service. In the VA benefits system, dental disabilities are treated differently from medical disabilities. VA regulations provide that treatable carious teeth, replaceable missing teeth, dental or alveolar abscesses, and periodontal disease will be considered service-connected solely for the purpose of establishing eligibility for outpatient dental treatment, not for compensation purposes. 38 C.F.R. § 3.381 (a) (2018). The exceptions to this general rule are listed under 38 C.F.R. § 4.150, Diagnostic Codes 9900 through 9916. Missing teeth may be compensable for rating purposes only where there is bone loss through trauma or disease such as osteomyelitis. See 38 C.F.R. § 4.150, Diagnostic Code 9913 (2018). However, the Note immediately following states that “these ratings apply only to bone loss through trauma or disease such as osteomyelitis and not to the loss of the alveolar process as a result of periodontal disease, since such loss is not considered disabling.” Id. The United States Court of Appeals for the Federal Circuit (Federal Circuit) defines “service trauma” as “an injury or wound produced by an external physical force during the service member’s performance of military duties.” This definition may encompass unintended results of treatment due to medical malpractice; however, it excludes the intended result of proper medical treatment. Nielson v. Shinseki, 607 F.3d. 802, 808 (Fed. Cir. 2010). A review of the Veteran’s service treatment record does not reflect any dental conditions. The report of the Veteran’s September 1971 examination prior to separation does not show any dental abnormalities were recorded. Apart from the Veteran’s statements in May 2015, the record does not contain any evidence of current dental problems. Notably, VA treatment records do not show any complaints of teeth or denture problems, and the Veteran has not identified any outstanding records of pertinent treatment, to include the treatment when he received his denture implants, despite be requested to do so in support of his claim. The Veteran does not have a current dental disorder that qualifies for VA disability compensation purposes. Although he has asserted that he suffered crack teeth from an in-service injury for which he later required denture replacements, the record, including the Veteran’s lay statements, do not indicate that he has bone loss through trauma or disease, such as osteomyelitis. See 38 C.F.R. § 4.150, Diagnostic Code 9913. As noted above, treatable carious teeth, replaceable missing teeth, dental or alveolar abscesses, and periodontal disease are not to be considered service connected for compensation purposes. 38 C.F.R. § 3.381 (a). Accordingly, as the preponderance of the evidence is against service connection for a dental disorder, to include cracked teeth, for compensation purposes, the benefit of the doubt doctrine does not apply, and the Veteran’s claim must be denied. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; Gilbert, 1 Vet. App. at 49. Increased Rating Disability evaluations are determined by application of the criteria set forth in the VA’s Schedule for Rating Disabilities, which is based on average impairment in earning capacity. 38 U.S.C. § 1155 (2012); 38 C.F.R. Part 4 (2018). An evaluation of the level of disability present must also include consideration of the functional impairment of the Veteran’s ability to engage in ordinary activities, including employment. 38 C.F.R. § 4.10 (2018). When a question arises as to which of two ratings apply under a particular diagnostic code, the higher evaluation is assigned if the disability more closely approximates the criteria for the higher rating. 38 C.F.R. § 4.7 (2018). Where the question for consideration is the propriety of the initial evaluation assigned, evaluation of the evidence since the grant of service connection and consideration of the appropriateness of a “staged rating” (assignment of different ratings for distinct periods of time, based on the facts found) is required. See Fenderson v. West, 12 Vet. App. 119, 126 (1999). 3. Entitlement to an initial compensable rating for bilateral hearing loss disability The Veteran seeks an initial increased rating for his bilateral hearing loss disability. He contends that his hearing loss disability is more severe than contemplated by the current assigned noncompensable rating. Relevant laws and regulations stipulate that evaluations of defective hearing range from noncompensable to 100 percent based on the organic impairment of hearing acuity. 38 C.F.R. § 4.85, Diagnostic Code 6100 (2018) Hearing impairment is measured by the results of controlled speech discrimination tests together with the average hearing threshold levels (which in turn, are measured by pure tone audiometric tests in the frequencies of 1000, 2000, 3000 and 4000 cycles per second (Hertz)). See Lendenmann v. Principi, 3 Vet. App. 345, 349 (1992) (defective hearing is rated on the basis of a mere mechanical application of the rating criteria). The provisions of 38 C.F.R. § 4.85 establish eleven auditory acuity levels from I to XI. Tables VI and VII as set forth in section 4.85(h) are used to calculate the rating to be assigned. In guidance for cases involving exceptional patterns of hearing impairment, the schedular criteria stipulates that, when the pure tone threshold at each of the four specified frequencies (1000, 2000, 3000 and 4000 Hertz) is 55 decibels or more, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VIa, whichever results in the higher numeral. 38 C.F.R. § 4.86 (a) (2018). Each ear is evaluated separately. Additionally, when the pure tone threshold is 30 decibels or less at 1000 Hertz, and 70 decibels or more at 2000 Hertz, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VIa, whichever results in the higher numeral. 38 C.F.R. § 4.86 (b) (2018). The numeral will then be elevated to the next higher Roman numeral. Id. Each ear will be evaluated separately. In April 2015, the Veteran was afforded a VA audiology examination in conjunction with his service connection claim. He complained of bilateral hearing loss which made it difficult for him to understand others during conversations, and he often had to ask them to repeat themselves, and he requires him to turn up the volume on the television. The Veteran’s speech recognition score, using the Maryland CNC, was 100 percent in right ear and 90 percent in the left ear. Audiometric testing revealed pure tone thresholds at 1000 to 4000 Hertz were as follows: 35, 35, 45, and 60 in the right ear; and 35, 35, 55, and 60 in the left ear. The Veteran had average pure tone thresholds of 46 in the left ear and 44 in the right ear. The Veteran has not asserted that his bilateral hearing loss disability has worsened since he was last examined by VA in 2015. See 38 U.S.C. § 5103A (d); 38 C.F.R. § 3.159 (c)(4); see also Snuffer v. Gober, 10 Vet. App. 400 (1997); Caffrey v. Brown, 6 Vet. App. 377 (1994). Accordingly, a remand is not warranted to afford the Veteran with a new VA examination based merely on passage of time. Palczewski v. Nicholson, 21 Vet. App. 174 (2007). Applying the method for evaluating hearing loss to the results of the Veteran’s three available audiological evaluations show the Veteran did not meet the exceptional pattern of hearing impairment under 38 C.F.R. § 4.86. Moreover, none of examiner certified that the use of speech discrimination test was not appropriate. Therefore, the numerical hearing impairment is determined only by Table VI. The April 2015 VA audiology examination report shows that the Veteran’s hearing acuity demonstrated pure tone threshold average of 46 with speech recognition of 90 percent in the left ear and pure tone threshold average of 44 with speech recognition of 100 percent in the right ear. Based on these results, the Veteran’s hearing acuity is assigned to Level I hearing for his right ear and Level II in his left ear according to Table VI. Combining Level I hearing for the right ear and Level II hearing for the left ear according to Table VII reveals a noncompensable rating. 38 C.F.R. § 4.85, Diagnostic Code 6100. In view of the above, an initial compensable rating for bilateral hearing loss is not warranted. See 38 C.F.R. § 4.85, Diagnostic Code 6100. The Board has considered the Veteran’s statements regarding the functional impact of his hearing loss on his daily life, including his difficulty understanding what others are saying. However, the Board finds that the Veteran’s functional impairment due to hearing loss is a disability picture that is specifically and adequately contemplated by the current schedular rating criteria. See Doucette v. Shulkin, 28 Vet. App. 366, 369-70 (2017) (finding that the rating criteria for hearing loss contemplate the functional effects of decreased hearing and difficulty understanding speech in an everyday work environment, as these are the effects that VA’s audiometric tests are designed to measure). For all the foregoing reasons, an initial compensable rating for hearing loss must be denied. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the doubt doctrine; however, given the mechanical nature of deriving schedular ratings for hearing loss, and that the preponderance of the evidence is against the claim, that doctrine is not applicable. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 4.3.   4. Entitlement to an initial rating in excess of 30 percent for posttrauamtic stress disorder (PTSD) disability The Veteran seeks a higher rating for his PTSD disability. He has been assigned a 30 percent rating for his PTSD disability pursuant to General Rating Formula for Rating Mental Disorders (General Rating Formula), 38 C.F.R. § 4.130, Diagnostic Code 9411 (2018). He contends that his PTSD disability is manifested by more severe symptoms than contemplated by the current assigned 30 percent rating. Pursuant to the General Rating Formula, a 30 percent rating is warranted when there is 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, weekly or less often panic attacks, 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 warranted when there is occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory such as, 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. 38 C.F.R. § 4.130, Diagnostic Code 9411. A 70 percent rating is warranted when there is occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to 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, or 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 the inability to establish and maintain effective relationships. 38 C.F.R. § 4.130, Diagnostic Code 9411. A maximum 100 percent rating 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 and place; memory loss for names of close relatives, own occupation, or own name. 38 C.F.R. § 4.130, Diagnostic Code 9411. The symptoms listed in the General Rating Formula are not intended to constitute an exhaustive list, but rather serve as examples of the type and degree of the symptoms, or effects thereof, that would justify a particular rating. Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). Accordingly, the evidence considered in determining the level of impairment under Diagnostic Code 9411 is not restricted to the symptoms provided in the diagnostic code. Instead, VA must consider all symptoms associated with the Veteran’s PTSD and their effect on the level of occupational and social impairment. Id. The Federal Circuit has clarified that the General Rating Formula requires not only (1) sufficient symptoms of the kind listed in the percentage requirements, or others of similar severity, frequency or duration; but also (2) that those symptoms cause the level of occupational and social impairment specified in the regulation. See Vazquez-Claudio v. Shinseki, 713 F.3d 112, 118 (Fed. Cir. 2013). The Veteran filed his claim for entitlement to service connection for PTSD in July 2014. The record shows he has received VA mental health treatment as well as undergone a VA psychiatric examination. A June 2014 VA treatment record shows that the Veteran presented to initiate VA care. He complained of mild depression and anger management problems, and he felt resentful for the way veterans were treated. He reported that he was divorced but he had a long-term girlfriend. He complained of night sweats but denied nightmares and suicidal thoughts. He was referred for VA mental health treatment assessment. A June 2014 VA initial mental health treatment assessment report shows the Veteran reported that he has been struggling with issues related to Vietnam for many years, and he finally sought assistance due to family pressure. The Veteran complained of symptoms of recurrent thoughts, disrupted sleep, vigilance, social isolation, challenges in relationships, feeling disconnected from his girlfriend, and anger about issues about stolen valor and Vietnam-related issues. He reported good relationships with his daughters, granddaughter, and girlfriend, but he denied any close relationships with friends. The Veteran was currently employed in a bait and tackle shop. On mental status examination, there was evidence of some concentration impairment, but no other abnormalities were recorded. He was diagnosed with PTSD and assigned a Global Assessment Functioning score of 60, which was indicative of moderate symptoms. Subsequent VA treatment records continued to show the Veteran complained of mild depression and anger problems, and he denied suicidal thoughts. In March 2015, the Veteran was afforded a VA psychiatric examination in conjunction with his service connection claim. Based on a thorough evaluation of the Veteran, the VA examiner diagnosed the Veteran as having “PTSD, chronic, mild.” The examiner reported that the Veteran’s PTSD symptoms included anxiety and chronic sleep impairment. The examiner observed the following behaviors during clinical evaluation: the Veteran was oriented; he was cooperative; he demonstrated good grooming and hygiene; he demonstrated an anxious mood; his speech and tone were within normal limits; his thought processes appeared logical and goal directed; his thought content appeared appropriate; his intellectual functioning appeared to be within the average range; his memory and concentration were intact; he denied experiencing hallucinations or delusions; his insight and judgment seemed good; and he denied suicidal/homicidal ideation. The March 2015 VA examiner characterized the Veteran’s symptomatology as indicative of occupational and social impairment due to mild or transient symptoms, which decreases work efficiency and ability to perform tasks during periods of stress. The examiner noted that the Veteran reported he had two children, with whom he had close relationships. He was divorced, but he had an “on and off” relationship with his girlfriend of eight years. He further reported that he had several friends, but none of whom, he felt he had a close relationship. The Veteran reported that he had worked in machine shop for ten years, and then worked in seafood institutional sales for 20 years until he could not do that job anymore because the company had moved further away and he had different bosses. The Veteran reported that he was currently employed at a bait and tackle shop for the past ten years. The Veteran has not asserted that his PTSD disability has worsened since he was last examined by VA in 2015. See 38 U.S.C. § 5103A (d); 38 C.F.R. § 3.159 (c)(4); see also Snuffer v. Gober, 10 Vet. App. 400 (1997); Caffrey v. Brown, 6 Vet. App. 377 (1994). Accordingly, a remand is not warranted to afford the Veteran with a new VA examination based merely on passage of time. Palczewski v. Nicholson, 21 Vet. App. 174 (2007). In a statement attached to his May 2015 notice of disagreement, the Veteran asserted that his PTSD symptoms were more severe than reflected by the current assigned 30 percent rating. He reported that the severity of his PTSD symptoms had impacted his relationships with others, and he believed it was the cause of his failed marriage and his difficulty working with others and maintaining friendships. The Veteran reported that his PTSD symptoms were worse immediately following the 9/11 terrorist attack, and he had confrontations with co-workers. The Veteran further reported that he walked away from his previous job because he could no longer get-along with his co-workers, and he sought employment where he could work by himself, despite the significant decrease in his annual income. Based on a review of the record, the Board finds that the Veteran is not entitled to a rating in excess of 30 percent at any point during the period under appeal. The Veteran’s PTSD symptoms were generally found to be at a mild level, and have been manifested by depressed mood, anxiety, chronic sleep impairment, and issues with anger management problems. The March 2015 VA examiner found that the Veteran’s PTSD symptomatology was indicative of no more than occupational and social impairment due to mild or transient symptoms, which decreases work efficiency and ability to perform tasks during periods of stress. Such symptomatology is contemplated by the current assigned 30 percent rating. See 38 C.F.R. § 4.130, Diagnostic Code 9411. The Board has considered the Veteran’s reports that he had a history of increased PTSD symptomatology following the events of the 9/11 terrorist attack and he felt that the need to leave his job in seafood sales because of his difficulty working with others. Notably, this reported increased symptomatology occurred well prior to the effective date of service connection for his PTSD disability, and has not been shown during the pendency of the appeal. Although a claimant’s history is considered, the regulations do not give past reports precedence over current findings. Rather, such evidence must be interpreted in light of the whole recorded history, reconciling the evidence into a consistent picture so that the current rating may accurately reflect the elements of disability present. See 38 C.F.R. § 4.1 (2018); Schafrath v. Derwinski, 1 Vet. App. 589 (1995). Here, the evidence during the pendency of the appeal demonstrates that the Veteran has been able to secure and maintain employment over a decade, despite the difficulties he experienced with PTSD symptoms, demonstrating his own interest and willingness to engage in work and a level of interpersonal skills while engaging with customers of the bait and tackle shop. Moreover, the Veteran has reported good relationships with his daughters and a comfortable relationship with his long-term girlfriend. These facts indicate positive social relationships and demonstrate that the Veteran does not have difficulty in establishing and maintaining effective social relationships to support the assignment of a higher evaluation under Diagnostic Code 9411. See 38 C.F.R. § 4.130. Additionally, the competent evidence of record does not demonstrate that the Veteran’s PTSD symptoms result in (for example) occupational and social impairment with reduced reliability and productivity. In fact, the Veteran’s primary PTSD symptoms anxiety and chronic sleep impairment are specifically contemplated by the previously assigned 30 percent disability rating. See 38 C.F.R. § 4.130, Diagnostic Code 9411. While VA treatment records do reflect the assignment of a GAF score of 60, which is suggestive of “moderate symptoms”, the Veteran’s thought processes, behavior, and appearance during each evaluation do not support a finding that the Veteran’s symptoms, which include depression, anxiety, irritability/hypervigilance, and nightmares/restless sleep, result in occupational and social impairment with reduced reliability and productivity. Further, at no time during this portion of the appeal period does the Veteran display 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 such as, retention of only highly learned material, forgetting to complete tasks; impaired judgment; impaired abstract thinking; or disturbances of motivation and mood. The Board finds that the competent evidence of record does not demonstrate that the severity of the Veteran’s PTSD disability supports the assignment of a 50 percent rating. See 38 C.F.R. § 4.130, Diagnostic Code 9411. Accordingly, the Board finds that the severity of the Veteran’s service-connected PTSD was adequately represented by the previously assigned 30 percent disability rating and an increased rating is not warranted. REASONS FOR REMAND 1. Entitlement to service connection for a neurologic condition, claimed as numbness and tingling, to include as due to exposure herbicide agents is remanded. The Veteran asserts that he has a neurologic condition, described as numbness and tingling in his hands that he believes is a result of his in-service exposure to herbicide agents. The Veteran is competent to describe his symptoms of numbness and tingling in his hands, which is sufficient to demonstrate of a current disability. In addition, the Veteran’s service personnel records show he had in-country service in the Republic of Vietnam, and his exposure to herbicide agents, including Agent Orange, is conceded. A remand is needed to afford the Veteran with a VA examination to determine the nature and etiology of his claimed neurologic condition involving his hands, to include as result of his in-service exposure to herbicide agents. The matter is REMANDED for the following action: Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any neurologic condition involving his hands. Following the review of the claims folder, the examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease, including in-service exposure to herbicide agents. A complete rationale for any opinion expressed must be given. Michael Pappas Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. Murray, Counsel