Citation Nr: 18153643 Decision Date: 11/28/18 Archive Date: 11/28/18 DOCKET NO. 18-43 901 DATE: November 28, 2018 ORDER An initial rating in excess of 30 percent for posttraumatic stress disorder (PTSD) after June 6, 2016, but prior to December 15, 2017, and a rating in excess of 70 percent thereafter is denied. FINDINGS OF FACT 1. After June 6, 2016, but before December 15, 2017, PTSD was more nearly manifested by symptoms productive of occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform tasks, but not more nearly by symptoms productive of occupational and social impairment with reduced reliability and productivity. 2. After December 15, 2017, PTSD was more nearly manifested by symptoms productive of occupational and social impairment with deficiencies in most areas; but not more nearly by symptoms productive of total occupational and social impairment. CONCLUSIONS OF LAW 1. The criteria for an evaluation in excess of 30 percent before December 15, 2017, for PTSD are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.130, Diagnostic Code 9411. 2. The criteria for an evaluation in excess of 70 percent from December 15, 2017, for PTSD are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.130, Diagnostic Code 9411. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served in the United States Army from September 1962 to December 1982. This case comes before the Board of Veterans’ Appeals (Board) on appeal from an August 2017 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). Increased Rating Disability evaluations are determined by the application of the VA Schedule for Rating Disabilities (Rating Schedule). 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and their residual conditions in civil occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Any reasonable doubt regarding the degree of disability will be resolved in favor of the claimant. 38 C.F.R. § 4.3. If two evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that evaluation; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. A disability may require re-evaluation in accordance with changes in a veteran’s condition. It is thus essential, in determining the level of current impairment, that the disability be considered in the context of the entire recorded history. 38 C.F.R. § 4.1. In August 2017, the RO granted service connection for PTSD and assigned a 30 percent rating, effective from June 6, 2016. The Veteran has disagreed with the initial disability evaluation assigned. In June 2018, the RO increased the rating for PTSD to 70 percent effective December 15, 2017. The Veteran has not indicated he is satisfied with the grant of the 70 percent rating assigned and the issue remains on appeal. As the Veteran here is appealing the original assignment of a disability evaluation following the award of service connection, the entire appeal period is to be considered to ensure that consideration is given to the possibility of staged ratings; that is, separate ratings for separate periods of time based on the facts found. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). The General Rating Formula for Mental Disorders, in pertinent part, provides for a rating of 30 percent if 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, panic attacks (weekly or less often), chronic sleep impairment, or mild memory loss (such as forgetting names, directions, recent events). 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 and maintaining effective work and social relationships. 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 that is 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. 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, or for the veteran’s own occupation or name. 38 C.F.R. § 4.130, Diagnostic Code 9411 (2017). Evaluation under § 4.130 is symptom-driven, meaning that symptomatology should be the fact-finder’s primary focus when deciding entitlement to a given disability rating under that regulation. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 116 -17 (Fed. Cir. 2013). In Vazquez-Claudio, the United States Court of Appeals for the Federal Circuit explained that the frequency, severity and duration of the symptoms also play an important role in determining the rating. Id. at 117. Significantly, however, the list of symptoms under the rating criteria are meant to be examples of symptoms that would warrant the rating, but are not meant to be exhaustive, and the Board need not find all or even some of the symptoms to award a specific rating. 38 C.F.R. § 4.21 ; Mauerhan v. Principi, 16 Vet. App. 436, 442-43 (2002). If the evidence shows that the Veteran suffers symptoms listed in the rating criteria or symptoms of similar severity, frequency, and duration, that cause occupational or social impairment equivalent to what would be caused by the symptoms listed in the criteria for a particular rating, the appropriate equivalent rating will be assigned. Mauerhan, 16 Vet. App. at 443 ; see also Vazquez-Claudio, 713 F.3d at 117. As with all claims for VA disability compensation, the Board must assess the credibility and weigh all the evidence, including lay and medical evidence, to determine its probative value, accounting for evidence which it finds to be persuasive or unpersuasive, and providing reasons for rejecting any evidence favorable to the claimant. Madden v. Gober, 125 F.3d 1477, 1481 (1997), cert. denied, 523 U.S. 1046 (1998). VA has recently changed its regulations, and now requires use of DSM-5 effective August 4, 2014. Among the changes, DSM-5 eliminates the use of the Global Assessment of Functioning (GAF) score in evaluation of psychiatric disorders. The change was made applicable to cases certified to the Board on or after August 4, 2014; and is not applicable to cases certified to the Board prior to that date. 79 Fed. Reg. 45093 (Aug. 4, 2014). This case was certified to the Board in August 2018. Therefore, the DSM-5 applies. Entitlement to an initial rating in excess of 30 percent for posttraumatic stress disorder (PTSD) prior to December 15, 2017, and a rating in excess of 70 percent thereafter. The Veteran’s claim for service connection was received by the VA on June 6, 2016. The claim was granted in an August 2017 RO decision with a 30 percent rating, effective the date of claim, June 6, 2016. The Veteran appealed the decision, and his rating was increased while the appeal was still pending. In a June 2018 decision, his rating was increased to 70 percent, effective December 15, 2017. Facts During a depression screening in September 2015, the Veteran responded “not at all” to a question about whether he was “feeling down, depressed, or hopeless.” He also had the same reply to a question as to whether he had “little interest or pleasure in doing things.” Results were also negative for a March 2016 depression screening and PTSD screening. In June 2016, the Veteran was seen for a new mental health evaluation. He denied any current suicidal or homicidal ideations. He was not judged to be an imminent risk for self-harm to others. Also in June 2016, the Veteran went to his first Vietnam veterans’ education group. A basic education about the group was provided, and he was noted to have participated in the discussion and asked appropriate questions. He was reported to be alert and oriented with active and appropriate participation. No acute indicators were noted during the session. Later in the month of June 2016, the Veteran underwent an initial PTSD VA examination. The VA examiner opined that the Veteran did not have a current diagnosis of PTSD. The Veteran reported he worked 26 years in schools where he could be around people, but he retired two years prior to the examination. He noted that the children and “everything” kept him from thinking about bad things. He stated that he retired medically because of arthritis “all over his body,” and he could not do things he once did because of it. It was reported that, since he retired, he had been working, not in an official capacity, as a mechanic and doing mechanical odd-jobs for customers and working on engines. However, recently he did not do it as much because of his health, and only did the mechanical work when he felt like it. He also stated that he thought about Vietnam and the people he left behind. He tried to stay active to avoid his thoughts, but he had these thoughts even more at night. He was previously sleeping 3-4 hours, but reported sleeping better with a change of medication. He said he thought he heard helicopters sometimes and he dreamed about seeing soldiers coming in. The Veteran was married for the third time for 25 years and described the marriage as wonderful. His spouse has two sons he loves dearly. He has grand kids and step grand kids. He described his relationship with his family as: “I love them and they love me” and they bear with him. He didn’t like to stay in his house but liked to get out and do things. The VA examiner reported that the Veteran was cooperative in conversation but his symptom endorsements were severe and were not corroborated by his presentation and self-descriptions. It was reported that objective symptom validity tests were failed. The Veteran's speech was of normal rate and volume. Mood was with a full range of affect. There wasn’t any evidence of mania or depression or overt anxiety. The examiner noted that the Veteran was calm and composed. Suicidal and homicidal ideations were denied. There were no preoccupation, delusions, obsessions, or compulsions. The Veteran did not have any hallucinations. He was not responding to internal stimuli. His hygiene and grooming were noted to be good. Rapport between the Veteran and the examiner was reported to be fairly easily established and maintained. Under validity, the examiner reported that the Veteran was given several symptom screening measures as well as self-report objective measures of symptom validity to assess over-reporting. Per the examiner’s notes, there are five subtests and a total score, with cut scores for each. The Veteran reported scores that indicated a high likelihood of feigning or symptoms exaggerations across multiple disorders including scales for depression and anxiety, neurologic impairments, amnestic disorders, low intelligence, psychosis, and total score (which was more than four times higher than the cut score). On every scale the he was given, he scored significant for over-reporting and improbable symptoms. Accordingly, the examiner noted that, while the Veteran may have had mild problems with a low mood or sleep disturbance, he did not, at the time of the examination, meet DSM-5 criteria for a mental disorders because there was no objective evidence of impairment or disorder. There was no history of mental health treatment in service or after service. The examiner stated that the Veteran's symptom profiles were significantly over endorsed and invalid. There was no obvious impairment in thought process or communication observed during the assessment. The examiner reported that the Veteran denied any social, occupational, or academic functioning problems. He was reported to be able to maintain basic activities of daily living (ADL’s) including personal hygiene. There was no evidence of inappropriate behavior. He was capable of managing VA benefits without assistance. The examiner also reported that the Veteran enjoyed group counseling at the VA because he liked having people to talk to. He had his first group counseling session the week before this examination. He reported that the Veterans enlightened him. No symptoms, for VA rating purposes, were checked by the examiner. In July 2016, the Veteran presented for a diagnostic evaluation with a chief complaint that things had gotten bad since he retired last year. He was seen by a VA clinical social worker. He reported having trouble sleeping, bad dreams, and a lot of memories from the war that were upsetting. He reported that when he was working, he could keep his memories at bay. However, since he retired after 30 years of working he had nightmares, and memories of his combat experiences and had been feeling depressed. He scored a 45 on the PCL-5 M. The Veteran reported extreme symptoms of: suddenly acting or feeling as if a stressful military experience were happening again; feeling very upset when something reminded him of the stressful military experience; having strong physical reactions (e.g. heart pounding, trouble breathing, etc.) when something reminded him of a stressful military experience, loss of interest in things that he used to enjoy; and trouble falling or staying asleep (four hours per night). He also reported experiencing quite often: repeated disturbing dreams of his stressful military experience; repeated disturbing memories, thoughts or images of a stressful military experience; having strong beliefs about himself, others, or the world; having difficulty concentrating; being super alert and on guard; being easily startled; having sleep disturbances; and feeling distant or cut off from other people. He reported he had moderate symptoms of avoiding memories, thoughts, or feelings related to the stressful experience, irritable behavior, angry outbursts, and acting aggressively. He reported had minor symptoms of avoiding external reminders of the stressful experience, having strong negative feelings such as fear, horror, anger, guilt, or shame; and having trouble experiencing positive feelings. He also said he had minor symptoms associated with taking risks of doing things that could harm him. A mental status examination was conducted. There were no abnormal movements. The Veteran was casually dressed and groomed. His speech was fluent and goal oriented. His mood was mildly depressed. His affect appropriate and congruent to mood. His thought processes were logical, coherent, and linear. He did not report and it was not noted that he had suicidal ideations, homicidal ideations, or visual or auditory hallucinations. His insight and judgment appeared to be fair to good, and his higher cortical functions remained grossly intact. The VA clinical social worker also noted that the Veteran used to drink a lot to cope, and that he quit drinking in 1988. He was diagnosed with PTSD and referred to psychiatry for a medication evaluation. An addendum to this evaluation referenced that the Veteran was prescribed escitalopram oxalate one month prior. Later in July 2016, the Veteran completed four of his PTSD group sessions. He discussed survivor’s guilt related to intense combat while in Vietnam. It was reported that this was the first time the Veteran talked about the event. He was noted to be alert and oriented with active and appropriate participation. He did not verbalize any suicidal or homicidal intent. In August 2016 the Veteran participated in four additional group sessions. He discussed anger management, depression, guilt and shame, and healthy communication. He was reported to be alert and oriented with active and appropriate participation at each session. He did not verbalize any suicidal intent or homicidal plans. In September 2016 the Veteran participated in three additional classes, he discussed previous topics, retirement, health issues and dealing with chronic pain, and effects on the family. He was reported to be alert and oriented with active and appropriate participation. He did not verbalize any suicidal or homicidal intent. A private psychologist, J.B. PhD, filled out an Initial PTSD Disability Benefits Questionnaire (DBQ) in October 2016. It was reported that the Veteran was retired and had a wonderful marriage and maintained a close relationship with all of his children. The Veteran told the private psychologist he was diagnosed with PTSD after being referred to the VA by his primary physician. He was then prescribed escitalopram, as discussed above. He reported symptoms of nightmares, history of alcohol and cannabis abuse, nervousness, ruminations on combat experiences, fleeting suicidal ideations, depressed mood, sleep difficulty, hypervigilance, irritability, social isolation, anger, outbursts, exaggerated response to loud noises, and sleep terrors. He stated that he had these symptoms for decades. He also told the clinician that he recently completed a PTSD treatment group which he found to be very helpful. He also reported he had suicidal ideations, but his love for his family acted as protective factors against self-harm. The private psychologist noted that a PTSD diagnosis was met. The clinician also reported that the Veteran had symptoms of depressed mood, anxiety, suspiciousness, and chronic sleep impairment. He instructed the reader to see additional symptoms in the discussion of medical history. The clinician reported that the Veteran’s PTSD symptoms manifested in occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and mood. The psychologist found the Veteran was fully oriented and aware. He was able to detail the impact of his chronic PTSD on his life and his relationships with loved ones during decades following his military experience. It was recommended that the Veteran receive psychiatric care to address these issues. In July 2017, the Veteran was seen for an initial VA PTSD examination. The examiner reported that the Veteran had a DSM-5 diagnosis of PTSD. He determined that the Veteran’s occupation and social impairment was due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress or symptoms controlled by medication. He reported that the Veteran exhibited symptoms of depressed mood, anxiety and suspiciousness. He noted that, while it was clear the Veteran had problems with depression and anxiety for a number of years, on self-report measure and in his interview with the Veteran there was a “clear exaggeration” of complaints. According to the VA examiner, the Veteran elevated five out of five scales of symptoms validity for overreporting of improbable symptoms. This was, per the VA examiner, far above set cutoff for overreporting. According to the examiner, while it was apparent the Veteran had mental health difficulties, his self-report of symptoms within the context of the C&P examination was questionable. Accordingly, as his self-reported symptoms were questionable, the examiner suggested that more objective measurements such as treatment, crisis intervention, and social relationships should be relied upon. The examiner opined that these other objective measurements pointed to mild impairment. The examiner also noted that the private opinion from D.B PhD, was inconsistent with the claimant’s own report of functioning in daily living. Later, the Veteran submitted a PTSD DBQ completed by a private psychologist, J.B. dated December 15, 2017. The noted history in this DBQ was very similar to the previous October 2016 DBQ that was completed. Again it was determined, that the Veteran had occupational and social impairment with deficiencies in most areas, such as work, school, family, relations, judgment, thinking, and mood. The examiner checked that the Veteran exhibited symptoms of depressed mood, anxiety, suspiciousness, panic attacks that occur weekly or less often, chronic sleep impairment, flattened affect, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, difficulty in adapting to stressful circumstances, including work or a worklike setting, suicidal ideations, impaired impulse control, such as unprovoked irritability with periods of violent, nightmares, nervousness, ruminations on combat experiences, fleeting suicidal ideations, depressed mood, sleep difficulty, hypervigilance, irritability, social isolation, anger outburst, exaggerated response to loud noises, and sleep terrors. The examiner remarked that the Veteran presented as fully oriented and aware during the evaluation. He was able to detail the impact of his chronic PTSD on his life and the lives of loved ones. He recalled vivid details regarding his trauma which resulted from his Vietnam deployments. He reported that the Veteran began to receive treatment for his PTSD in 2014, and is actively engaged in treatment for his diagnosed condition. Therefore, he opined, that the Veteran was unable to sustain employment due to his age, mental condition, and the debilitating impact of both on his ability to engage in sedentary or physical vocational activities. While the record indicates that the RO has made two recent attempts to get more medical records from the Veteran’s private psychologist regarding his current treatment, there have not been any additional records concerning his most recent treatment for his PTSD. A. After June 6, 2016 and before December 15, 2017 The medical evidence in the record does not support a finding that the Veteran’s PTSD disability warranted a rating in excess of 30 percent after June 6, 2016 but before December 15, 2017. The weight of the evidence (including affirmative findings by a VA mental health professional and his private psychologist) shows that the Veteran did not have most of the symptoms referenced in the criteria for a 50 percent rating, including: flattened affect; stereotyped speech; impairment of short- and long-term memory, and maintaining effective work and social relationships. At his June 2016 VA examination, the VA examiner observed that the Veteran's mood was with full and congruent with range of affect. He noted that there was no evidence of mania or depression or overt anxiety. It was observed that there were not any obvious impairments in the Veteran's communication, and that his speech was of normal rate, volume and prosody. The examiner reported that the Veteran was calm and composed. Also, at his group sessions from June 2016 to September 2016 the Veteran was consistently noted to be alert and oriented and as having active and appropriate participation. In July 2016, as discussed above, a VA clinical social worker reported the Veteran's speech was fluent and goal oriented; his affect appropriate and congruent to mood; and his thought processes were logical, coherent, and linear. Moreover, at his October 2016 private examination, the private psychologist reported that the Veteran was fully oriented and aware and able to detail the impact of his PTSD on his life. These objective observations do not indicate a higher rating is warranted for this period on appeal. While the Veteran reported having bad nightmares and memories associated with his Vietnam tours, his ability to recall was not an issue in any of the three examinations during this period on appeal. The Veteran, as noted in his private October 2016 examination, was able to recall memories associated with his Vietnam experiences and his recent PTSD group sessions. Most importantly, the evidence also does not indicate the Veteran had difficulty in establishing and maintaining effective work and social relationships. While the Veteran reported at his initial PTSD VA examination that he had already been retired during this period on appeal, there is evidence that substantiates the Veteran maintained the ability to establish work relationships. The Veteran reported doing mechanic work for people after he retired, and that he retired not because of his PTSD but due to his arthritis and physical limitations. Moreover, the record indicates that, instead of making it difficult to maintain social interaction because of his PTSD symptoms, social interaction alleviated the Veteran’s PTSD symptoms. He reported in his initial PTSD VA examination that working with kids relieved and distracted him from his Vietnam memories for almost 30 years. Additionally, the VA examiner reported that, after his group therapy sessions, the Veteran remarked that he felt enlightened and enjoyed interacting with people. Moreover, the record indicates the Veteran has been able to maintain a relationship with his wife and kids during this period on appeal. While the Board notes the Veteran reported an exhaustive list of symptoms associated with his PTSD, his lay reports are not supported by the medical observations of the VA examiner and his private psychologist on record. While the Board finds the Veteran is competent to describe his symptoms associated with his mental disorder, the Board finds his observations less probative than the observations of those with the specialized knowledge of mental disorders, particularly the VA examiner who performed the VA examinations during this appeal period. In making this finding, the Board acknowledges his private psychologist’s determination in October 2016 indicated that the Veteran’s occupational and social impairment warranted a 70 percent rating. The Board finds that this opinion is not congruent with other evidence of record which undercuts its evidentiary value. While the October 2016 private DBQ details the Veteran’s reports on his mental disorder and the Veteran’s relevant medical history, the private psychologist did not tie his opinion and occupational and social impairment determination to the facts. As such, while the examination contained medical determinations, it lacked adequate rationale in support of these findings. Notably, this inadequacy was addressed in the August 2017 VA examination which stated that the private October 2016 opinion from D.B PhD was inconsistent with the claimant’s own report of functioning in daily living. Accordingly, the Board finds the private psychologist’s determinations in the October 2016 DBQ have reduced probative value and is outweighed by the October 2016 opinion. The Board has considered the Veteran’s contentions in his April 2018 notice of disagreement (NOD) associated with his TDIU claim. Essentially, the Veteran purported that the RO did not consider the favorable evidence of his private examiner which would entitle him to a 70 percent rating. Notably, this was prior to the Veteran’s 70 percent increase in June 2018. However, it is relevant to the period on appeal prior to December 15, 2017. Therefore, as discussed above, the Veteran’s private mental professional’s opinion has been considered. However, as stated, this mental opinion is largely based on the Veteran’s lay reports to the mental health professional and lacks an adequate rationale. To the contrary, the VA examiner in August 2017 gave an adequate explanation for her findings which included a thorough explanation of validity of testing of mental health symptoms alleged by the Veteran. The validity discussion serves as supporting evidence for the Board’s determination to reduce the probative weight of the Veteran’s reported symptomatology associated with his PTSD. Moreover, as stated, the medical record does not support and corroborate the Veteran’s reported severity of PTSD symptoms. Accordingly, the Board finds the VA examiner’s findings in the August 2017 VA examination are more probative, and the Veteran’s arguments in the April 2018 notice of disagreement concerning this period on appeal are not persuasive. Moreover, in the context of determining whether a higher disability evaluation is warranted under Diagnostic Code 9411, the analysis requires considering “not only the presence of certain symptoms[,] but also that those symptoms have caused occupational and social impairment in most of the referenced areas” - i.e., “the regulation... requires an ultimate factual conclusion as to the Veteran’s level of impairment in ‘most areas.’” Vazquez-Claudio, 713 F.3d at 117-18; 38 C.F.R. §4.130, Diagnostic Code 9411. Therefore, even taking his reports at face value, the record does not support a finding that these reported symptoms have caused occupational and social impairment with reduced reliability and productivity. As discussed, these reported symptoms have not been connected to hindering the Veteran in his interaction with other Veterans, his family members, and clients of his mechanic business during the appeal period. Moreover, they did not lead to the Veteran’s retirement. The Board’s finding has taken into consideration the Veteran’s report of fleeting suicidal ideations to his private psychologist in September 2016 in the context of the recent Bankhead v. Shulkin case which noted that suicidal ideation appears only in the 70 percent evaluation criteria and that there are no analogues at the lower levels; thus, evidence beyond suicidal thoughts is not required for a 70 percent rating. See Bankhead v. Shulkin, 29 Vet. App. 10, 20 -21 (2017). However, the preponderance of the evidence is against finding that the Veteran’s PTSD has manifested in suicidal ideations during the period on appeal. The Veteran denied suicidal ideations in June 2016 during a mental health evaluation and his initial VA PTSD examination. Suicidal ideations were also denied and not observed by the clinical social worker in July 2016. The Veteran also did not verbalize any suicidal intent at any of his group therapy sessions. Nevertheless, even after Bankhead, the analysis for a PTSD increased rating claim still requires a consideration of the total occupational and social impairment. “VA must engage in a holistic analysis in which it assesses the severity, frequency, and duration of the signs and symptoms of the veteran’s service-connected mental disorder; quantifies the level of occupational and social impairment caused by those signs and symptoms; and assigns an evaluation that most nearly approximates that level of occupational and social impairment.” Bankhead, 29 Vet. App. at 22 (internal citations omitted). In this case, the total occupational and social impairment displayed during the appeal period does not warrant a higher rating. There is no indication that the suicidal ideation was productive of any industrial or social impairment. Accordingly, the Board finds evidence of fleeting suicidal ideations is not enough to warrant a 70 percent rating for this claim. As such, the Board finds the Veteran’s disability picture is consistent with a social and occupational level at a 30 percent rating, and the record does not support a finding that a 50 percent rating is warranted at any time during the pertinent time period. Therefore, the claim for increase of the initial rating is denied. B. After December 15, 2017 As discussed in the fact section above, the Veteran’s private psychologist submitted an additional PTSD DBQ with reported symptoms consistent with a 70 percent rating. The RO based its increase to 70 percent on this examination. However, the Board finds that the evidence does not more nearly reflect the severity, frequency or duration of symptoms that comport with total social occupational and social impairment. None of the mental health providers who have examined the Veteran have found him to have total occupational and social impairment, including his private mental health provider. The Board finds the medical opinions, in this regard, highly probative as it was provided by skilled, neutral medical professionals after evaluating the Veteran. The records do not reflect the presence of symptoms enumerated under the criteria for a 100 percent rating. While the Board acknowledges the Veteran’s private psychologist’s statement that the Veteran was unable to sustain employment due to − in part − his mental condition, the medical evidence does not indicate the Veteran’s symptoms were of the frequency and duration to support a 100 percent rating at this period on appeal. The Board has considered the Veteran’s report of his PTSD symptoms during this period on appeal and accepts that the Veteran is competent to report his symptoms. However, whether a disability meets the schedular criteria for the assignment of a higher evaluation is a factual determination by the Board based on the Veteran’s complaints coupled with the medical evidence. Both the lay and medical evidence are probative in this case. Although the Veteran may believe that he meets the criteria for the next higher disability rating, his complaints along with the medical findings do not meet the schedular requirements for a 100 percent evaluation, as explained and discussed above. The Board finds the evidence of record does not support a finding that the Veteran's service connected mental disorder was productive of total social and/or industrial incapacity. The evidence demonstrates that the Veteran is able to maintain effective relationships with his family and other Veterans and is also able to work when he wants to. This employment is voluntarily limited by the Veteran which suggests to the Board that his industrial capacity could be increased. This weighs against a finding that the Veteran has complete industrial incapacity. Accordingly, a rating in excess of 70 percent from December 15, 2017 for PTSD is denied. Further staging of the rating is not warranted. See Fenderson v. West, 12 Vet. App. 119, 126 (2001); Hart v. Mansfield, 21 Vet. App. 505 (2007). G. A. WASIK Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Department of Veterans Affairs