Citation Nr: 18158916 Decision Date: 12/18/18 Archive Date: 12/18/18 DOCKET NO. 10-27 702A DATE: December 18, 2018 ORDER The appeal of the claim for an initial rating in excess of 10 percent for left knee patellofemoral syndrome is dismissed. The appeal of the claim for a TDIU prior to July 28, 2014 is dismissed. Service connection for sleep apnea is denied. An initial rating in excess of 10 percent for mitral valve prolapse with bradycardia and angina prior to May 6, 2013 is denied. An initial rating in excess of 30 percent for mitral valve prolapse with bradycardia and angina from May 6, 2013 is denied. An initial rating in excess of 30 percent for posttraumatic stress disorder (PTSD) prior to July 28, 2014 is denied. An initial rating in excess of 70 percent for PTSD from July 28, 2014 is denied. FINDINGS OF FACT 1. On February 2, 2018, prior to the promulgation of a decision in the appeal, the Board received notification from the Veteran, through the authorized representative, requesting a withdrawal of the appeal of the claims for an initial rating in excess of 10 percent for left knee patellofemoral syndrome and a TDIU prior to July 28, 2014. 2. The Veteran’s sleep apnea is neither proximately due to nor aggravated beyond its natural progression by his service-connected PTSD, and is not otherwise related to an in-service injury, event, or disease. 3. Prior to May 6, 2013, the Veteran’s mitral valve prolapse with bradycardia and angina had not been manifested by a workload of greater than 5 METs but not greater than 7 METs resulting in dyspnea, fatigue, angina, dizziness, or syncope; or evidence of cardiac hypertrophy or dilatation on electrocardiogram, echocardiogram, or X-ray. 4. From May 6, 2013, the Veteran’s mitral valve prolapse with bradycardia and angina has not been manifested by more than one episode of acute congestive heart failure in the past year; or a workload of greater than 3 METs but not greater than 5 METs resulting in dyspnea, fatigue, angina, dizziness, or syncope; or left ventricular dysfunction with an ejection fraction of 30 to 50 percent. 5. Prior to July 28, 2014, the Veteran’s PTSD had not resulted in occupational and social impairment with reduced reliability and productivity. 6. From July 28, 2014, the Veteran’s PTSD has not resulted in total occupational and social impairment. CONCLUSIONS OF LAW 1. The criteria for withdrawal of the appeal of the claims for an initial rating in excess of 10 percent for left knee patellofemoral syndrome and a TDIU prior to July 28, 2014 by the Veteran’s authorized representative have been met. 38 U.S.C. § 7105(b)(2), (d)(5); 38 C.F.R. § 20.204. 2. The criteria for service connection for sleep apnea have not been met. 38 U.S.C. §§ 1110 (wartime), 1131 (peacetime), 5107(b); 38 C.F.R. §§ 3.102, 3.310(a). 3. The criteria for an initial rating in excess of 10 percent for mitral valve prolapse with bradycardia and angina prior to May 6, 2013 have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.104, Diagnostic Code 7011. 4. The criteria for an initial rating in excess of 30 percent for mitral valve prolapse with bradycardia and angina from May 6, 2013 have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.104, Diagnostic Code 7011. 5. The criteria for an initial rating in excess of 30 percent for PTSD prior to July 28, 2014 have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.130, Diagnostic Code 9411. 6. The criteria for an initial rating in excess of 70 percent for PTSD from July 28, 2014 have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.130, Diagnostic Code 9411. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS In a February 2016 decision, the Board denied the Veteran’s claims for service connection for a gastrointestinal disability and an initial rating in excess of 10 percent for a left knee disability. The Board also granted a 40 percent rating for a low back disability, a 30 percent rating for a left shoulder disability, and a 10 percent rating for a right thumb disability; and remanded the claims for service connection for erectile dysfunction and sleep apnea, increased ratings for mitral valve prolapse with bradycardia and angina and posttraumatic stress disorder (PTSD), and a total disability rating based on individual unemployability (TDIU) prior to July 28, 2014. The Veteran appealed that decision to the United States Court of Appeals for Veterans Claims. Pursuant to a joint motion for partial remand, in a January 2017 Order, the Court remanded that part of that Board decision that denied service connection for a gastrointestinal disorder, including gastroesophageal reflux disease (GERD) and a rating in excess of 10 percent for the left knee patellofemoral syndrome for readjudication in accordance with the joint motion. A November 2017 rating decision granted service connection for GERD and erectile dysfunction. Thus, those issues are no longer on appeal. While a January 2018 supplemental statement of the case included the issues of increased ratings for left acromioclavicular joint sprain, degenerative changes of the lumbar spine, and residuals of a right thumb sprain with osteoarthritis, those issues were decided by the Board in the February 2016 decision and, as such, are no longer on appeal. In a February 2, 2018 response to the January 2018 supplemental statement of the case, the Veteran’s representative indicated that he wished to continue the appeal of the claim for service connection for erectile dysfunction. However, as noted above, that claim has been granted. Thus, that issue is also no longer on appeal. Withdrawal The Board may dismiss any appeal which fails to allege specific error of fact or law in a determination being appealed. 38 U.S.C. § 7105 (2012). A substantive appeal may be withdrawn on the record during a hearing, and at any time before the Board promulgates a decision. 38 C.F.R. §§ 20.202, 20.204 (2018). Withdrawal may be made by the Veteran or the authorized representative. 38 C.F.R. § 20.204 (2018). 1. An initial rating in excess of 10 percent for left knee patellofemoral syndrome 2. A TDIU prior to July 28, 2014 In a February 2, 2018 response to the January 2018 supplemental statement of the case, the Veteran’s representative indicated that he only wished to continue the appeal with respect to the claims for service connection for sleep apnea and increased ratings for mitral valve prolapse with bradycardia and angina and PTSD. As such, the Veteran effectively withdrew the appeal of the claims for an initial rating in excess of 10 percent for left knee patellofemoral syndrome and a TDIU prior to July 28, 2014. Thus, the Board finds that on February 2, 2018, prior to the promulgation of a decision in the appeal, the Board received notification from the Veteran, through the authorized representative, requesting a withdrawal of the appeal of the claims for an initial rating in excess of 10 percent for left knee patellofemoral syndrome and a TDIU prior to July 28, 2014. Therefore, there remain no allegations of errors of fact or law for appellate consideration with respect to these claims. Accordingly, the Board does not have jurisdiction to review the appeal as to these claims, and they must be dismissed. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131 (2012); 38 C.F.R. § 3.303(a) (2018). Service connection may be granted for any disease 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) (2018). Service connection requires competent evidence of (1) a current disability; (2) the incurrence or aggravation of a disease or injury during service; and (3) a causal relationship between the current disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). 3. Service connection for sleep apnea The Veteran asserts that his sleep apnea is secondary to his service-connected PTSD. Service treatment records do not show any complaints, findings, or diagnoses of sleep apnea. Private medical records show that the Veteran complained of being more tired and sleeping more for the past month in August 2007, and of poor and interrupted sleep in September 2007. However, a diagnosis of sleep apnea was not rendered, nor was a sleep study recommended. VA medical records show that the Veteran was diagnosed with obstructive sleep apnea in May 2012. At an April 2017 VA examination, the Veteran reported being diagnosed with sleep apnea in 2013. In a separate medical opinion, the examiner opined that the Veteran’s sleep apnea was not incurred in or caused by active service. The examiner noted the Veteran’s complaints of fatigue in the service treatment records but stated that fatigue is not a known risk factor for the development of sleep apnea. The examiner further stated that the complaints of fatigue were associated with a viral upper respiratory illness and not consistent with symptoms seen in obstructive sleep apnea. The examiner also opined that the Veteran’s sleep apnea was not proximately due to, the result of, or aggravated by a service-connected disability. The examiner noted that PTSD has been shown to have an associative relationship with obstructive sleep apnea but a causal or worsening relationship has not been born out in the literature. Medical treatise evidence submitted by the Veteran indicates that sleep apnea is elevated in Veterans with PTSD but the reason was not clear. Given the above, the Veteran’s sleep apnea is neither proximately due to nor aggravated beyond its natural progression by his service-connected PTSD, and is not otherwise related to an in-service injury, event, or disease. Sleep apnea was not diagnosed until 17 years after discharge from service. While not dispositive, the passage of so many years between discharge from active service and the objective documentation of a claimed disability is a factor that weighs against a claim for service connection. Maxson v. Gober, 230 F.3d 1330 (Fed. Cir. 2000). Even if the Veteran’s reports of being tired in August 2007 were symptoms of sleep apnea, that still dates the onset of the disorder to 12 years after discharge from service. Moreover, a VA examiner has opined that the Veteran’s sleep apnea is not related to service or a service-connected disability, including PTSD. The Board notes the medical treatise evidence submitted by the Veteran but observes that, as aptly pointed out by the examiner, the current medical literature, including that submitted by the Veteran, does not show a causal or worsening relationship between PTSD and sleep apnea. The Board notes that a lay person is competent to give evidence about observable symptoms such as fatigue. Layno v. Brown, 6 Vet. App. 465 (1994). The Board also notes that a lay person is competent to address the etiology of a disability in some limited circumstances in which nexus is obvious merely through lay observation, such as a fall leading to a broken leg. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). While the Board appreciates the Veteran’s statements regarding disability onset and chronicity of symptomatology, in this case, the record dates the onset of symptoms to at least 12 years after separation from active service and the questions of diagnosis and causation extend beyond an immediately observable cause-and-effect relationship. As such, the Veteran is not competent to address the diagnosis or etiology of his disability. In conclusion, service connection for sleep apnea is not warranted. As the preponderance of the evidence is against the claim, the claim must be denied. 38 U.S.C. § 5107(b) (2012); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Increased Rating Disability ratings are determined by applying the criteria set forth in the VA’s Schedule for Rating Disabilities, which is based on the average impairment of earning capacity resulting from disability. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155 (2012); 38 C.F.R. § 4.1 (2018). Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7 (2018). Any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran. 38 C.F.R. § 4.3 (2018). 4. An initial rating in excess of 10 percent for mitral valve prolapse with bradycardia and angina prior to May 6, 2013 Effective May 16, 2008, the Veteran’s mitral valve prolapse with bradycardia and angina was evaluated at 10 percent under Diagnostic Code 7011. 38 C.F.R. § 4.104 (2018). Under Diagnostic Code 7011 for ventricular arrhythmias, a 100 percent rating is warranted for an indefinite period from date of hospital admission for initial evaluation and medical therapy for a sustained ventricular arrhythmia, or for an indefinite period from date of hospital admission for ventricular aneurysmectomy, or with an automatic implantable Cardioverter-Defibrillator in place. A 100 percent rating is also warranted for chronic congestive heart failure; or a workload of 3 METs or less resulting in dyspnea, fatigue, angina, dizziness, or syncope; or left ventricular dysfunction with an ejection fraction of less than 30 percent. A 60 percent rating is warranted for more than one episode of acute congestive heart failure in the past year; or a workload of greater than 3 METs but not greater than 5 METs resulting in dyspnea, fatigue, angina, dizziness, or syncope; or left ventricular dysfunction with an ejection fraction of 30 to 50 percent. A 30 percent rating is warranted for a workload of greater than 5 METs but not greater than 7 METs resulting in dyspnea, fatigue, angina, dizziness, or syncope; or evidence of cardiac hypertrophy or dilatation on electrocardiogram, echocardiogram, or X-ray. A June 2009 VA examination revealed a METs of 10. Private medical records show that a February 2009 chest x-ray revealed that heart size was borderline cardiomegaly. A February 2009 echocardiogram revealed an ejection fraction 68 percent. A September 2009 stress test revealed a METs of 11. An October 2009 chest x-ray revealed that the heart was normal in size. A December 2010 VA examination revealed no evidence of congestive heart failure, cardiomegaly, or cor pulmonale. An echocardiogram revealed an ejection fraction of 59 percent and that the heart was normal in size. The examiner noted that the estimated METs level was 3 to 5. The examiner provided diagnoses of ischemic cardiomyopathy, mitral valve prolapse, angina, and bradycardia. The examiner noted that the mitral valve prolapse was quiescent. The examiner noted that the Veteran’s ischemic cardiomyopathy is not related to mitral valve prolapse, which has no relation to coronary artery lesions. Private medical records show that a March 2011 stress test revealed a METs of 12. An October 2011 chest x-ray revealed that the heart was normal in size. Initially, as will be discussed below, the Veteran’s METs level has been attributed to a nonservice-connected heart condition. Thus, the METs of 3 to 5 will not be used to evaluate his mitral valve prolapse with bradycardia and angina. Given the above, prior to May 6, 2013, while the February 2009 chest x-ray revealed that heart size was borderline cardiomegaly, the remainder of the diagnostic evidence through October 2011 revealed that the heart was normal in size. There was no evidence of dilatation. As such, the Board finds that the Veteran’s mitral valve prolapse with bradycardia and angina had not been manifested by a workload of greater than 5 METs but not greater than 7 METs resulting in dyspnea, fatigue, angina, dizziness, or syncope; or evidence of cardiac hypertrophy or dilatation on electrocardiogram, echocardiogram, or X-ray. Thus, a higher 30 percent rating is not warranted. In conclusion, an initial rating in excess of 10 percent for mitral valve prolapse with bradycardia and angina prior to May 6, 2013 is not warranted. As the preponderance of the evidence is against the claim, the claim must be denied. 38 U.S.C. § 5107(b); Gilbert, 1 Vet. App. 49. 5. An initial rating in excess of 30 percent for mitral valve prolapse with bradycardia and angina from May 6, 2013 From May 6, 2013, the Veteran’s mitral valve prolapse with bradycardia and angina has been evaluated at 30 percent under Diagnostic Code 7011. 38 C.F.R. § 4.104. A November 2014 VA echocardiogram revealed an ejection fraction of 60 percent and mild left ventricular hypertrophy. A December 2014 VA examination revealed a METs of 5 to 7. The examiner provided diagnoses of coronary artery disease, stable angina, mitral valve prolapse, and atrial fibrillation. Chest x-rays revealed that the heart was normal in size. The examiner noted that as echocardiogram and clinical examination revealed no evidence of bradycardia, the diagnosis of the service-connected disorder was changed to mitral valve prolapse. The examiner noted that x-rays showed cardiac hypertrophy but not dilatation. The examiner stated that the Veteran will not be able to perform strenuous physical activity due to his heart condition. In a separate medical opinion, the examiner opined that the Veteran’s coronary artery disease and atrial fibrillation were not aggravated by the mitral valve prolapse with bradycardia and stable angina, as those conditions are not related to mitral valve prolapse. The examiner opined that the Veteran’s mild ventricular hypertrophy and mitral regurgitation were aggravated by the mitral valve prolapse, as they can be caused by mitral valve prolapse. An April 2017 VA examination revealed diagnoses of coronary artery disease, mitral valve prolapse, and left ventricular dysfunction. Echocardiogram showed an ejection fraction of 56 percent. X-rays revealed left ventricular enlargement. The examiner indicated that there was no evidence of congestive heart failure or cardiac hypertrophy. The examiner estimated the METS as 3 to 5. The examiner noted that the mitral valve prolapse was active. In a September 2017 VA medical opinion, another examiner stated that the Veteran’s mitral valve prolapse was asymptomatic since no specific complaints were rendered, the bradycardia was either resolved or quiescent since the EKG was normal, and there was no specific mention of angina in the April 2017 examination report. The examiner stated that the Veteran was noted as having a METs of 3 to 5 with dyspnea and fatigue which appears to be at least as likely associated with his left ventricular dysfunction or due to mitral valve prolapse. The examiner noted that the angina complaints including CAD was quiescent at the time of the earlier examination. In a November 2017 addendum, the examiner clarified that the Veteran’s METs of 3 to 5 with dyspnea and fatigue appears to be at least as likely associated with his left ventricular dysfunction and less likely due to mitral valve prolapse. Thus, the Veteran’s METs level will not be used to evaluate his service-connected disability. Given the above, the Veteran has not had any episodes of acute congestive heart failure and his ejection fraction has been above 50 percent. As such, the Board finds that from May 6, 2013, the Veteran’s mitral valve prolapse has not been manifested by more than one episode of acute congestive heart failure in the past year; or a workload of greater than 3 METs but not greater than 5 METs resulting in dyspnea, fatigue, angina, dizziness, or syncope; or left ventricular dysfunction with an ejection fraction of 30 to 50 percent. While the September 2017 examiner initially attributed the Veteran’s METs of 3 to 5 to the mitral valve prolapse, the examiner later clarified that it was attributable to the nonservice-connected left ventricular dysfunction. The examiner further clarified that the Veteran’s mitral valve prolapse was asymptomatic at the April 2017 examination. Thus, a higher 60 percent rating is not warranted. In conclusion, an initial rating in excess of 30 percent for mitral valve prolapse with bradycardia and angina from May 6, 2013 is not warranted. As the preponderance of the evidence is against the claim, the claim must be denied. 38 U.S.C. § 5107(b); Gilbert, 1 Vet. App. 49. 6. An initial rating in excess of 30 percent for PTSD prior to July 28, 2014 Effective May 6, 2013, the Veteran’s PTSD has been evaluated at 30 percent under Diagnostic Code 9411. 38 C.F.R. § 4.130 (2018). The rating criteria provide for a 100 percent rating where the evidence shows 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. The rating criteria provide for a 70 percent rating where the evidence shows occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence) spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); inability to establish and maintain effective relationships. The rating criteria provide for a 50 percent rating where the evidence shows 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; difficulty in establishing and maintaining effective work and social relationships. The rating criteria provide for a 30 percent rating where the evidence shows occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events). The psychiatric symptoms listed in the above rating criteria are not exclusive, but are examples of typical symptoms for the listed percentage ratings. Mauerhan v. Principi, 16 Vet. App. 436 (2002). The Global Assessment of Functioning (GAF) score is a scale indicating the psychological, social, and occupational functioning on a hypothetical continuum of mental health and illness. The GAF score assigned in a case, like an examiner’s assessment of the severity of a condition, is not dispositive of the evaluation issue; rather, the GAF score must be considered in light of the actual symptoms of the Veteran’s disorder, which provide the primary basis for the rating assigned. 38 C.F.R. § 4.126(a) (2018). While the record shows that the Veteran has been unemployed since December 1996, the record does not show that his PTSD has resulted in occupational and social impairment with reduced reliability and productivity. At a February 2014 VA examination, the Veteran reported symptoms of depressed mood, anxiety, suspiciousness, panic attacks that occur weekly or less often, chronic sleep impairment, mild memory loss, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, and difficulty in adapting to stressful circumstances, including work or a worklike setting. He reported having a good relationship with his wife and children. The examiner indicated that the Veteran’s PTSD results in occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care and conversation. The examiner’s assessment of the severity of the Veteran’s PTSD falls squarely within the rating criteria for the currently assigned 30 percent rating. While the Veteran reported two symptoms which support a 50 percent rating—disturbances of motivation and mood, and difficulty in establishing and maintaining effective work and social relationships—the majority of his symptoms support a 30 percent rating. Moreover, while an October 2013 VA medical record shows that his mood was up and down, it does not reflect any disturbance of motivation or difficulty in establishing and maintaining effective work and social relationships. Furthermore, December 2013, March 2014, and June 2014 VA medical records show that mood was steady. The October 2013 record also shows a GAF score of 58, which the Board observes indicates moderate symptoms (e.g., flat affect and circumstantial speech, occasional panic attacks). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). While the Veteran’s affect was reportedly subdued at the time of the October 2013 visit, he did not exhibit circumstantial speech, and the current 30 percent rating contemplates occasional panic attacks. Thus, the severity and frequency of the Veteran’s symptoms as a whole do not support a higher 50 percent rating. Here, the Board reiterates the February 2014 examiner’s overall conclusion that the Veteran’s PTSD resulted in occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care and conversation—the criteria for a 30 percent rating. In conclusion, an initial rating in excess of 30 percent for PTSD prior to July 28, 2014 is not warranted. As the preponderance of the evidence is against the claim, the claim must be denied. 38 U.S.C. § 5107(b); Gilbert, 1 Vet. App. 49. 7. An initial rating in excess of 70 percent for PTSD from July 28, 2014 From July 28, 2014, the Veteran’s PTSD has been evaluated at 70 percent under Diagnostic Code 9411. 38 C.F.R. § 4.130. Since July 28, 2014, while the record shows that the Veteran’s PTSD has resulted in serious occupational and social impairment, the record does not show that his PTSD has resulted in total occupational and social impairment. At a March 2015 VA examination, the Veteran reported symptoms of depressed mood, suspiciousness, panic attacks more than once a week, near-continuous panic or depression, chronic sleep impairment, mild memory loss, and difficulty in adapting to stressful circumstances, including work or a worklike setting. He reported having a good relationship with his wife and children. The examiner indicated that the Veteran’s PTSD results in occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care and conversation. The examiner’s assessment of the severity of the Veteran’s PTSD actually falls within the rating criteria for a 30 percent rating. Thus, the examiner’s assessment is clearly against a finding of total occupational and social impairment. Moreover, the Veteran did not report any of the symptoms indicative of a 100 percent rating. At an April 2017 VA examination, the Veteran reported symptoms of depressed mood, anxiety, suspiciousness, chronic sleep impairment, mild memory loss, and difficulty in establishing and maintaining effective work and social relationships. He reported having a fair relationship with his wife and children. The examiner indicated that the Veteran’s PTSD results in occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care and conversation. The examiner remarked that the Veteran’s PTSD results in moderate impairment. This examiner’s assessment of the severity of the Veteran’s PTSD also falls within the rating criteria for a 30 percent rating. Thus, this examiner’s assessment is also clearly against a finding of total occupational and social impairment. The Veteran again did not report any of the symptoms indicative of a 100 percent rating. The Board observes that the Veteran is not working. However, even if his PTSD has resulted in total occupational impairment, his PTSD has not resulted in total social impairment, which is also required for a 100 percent rating. While he has only fair relationships with his wife and children, he has been able to maintain those relationships. Given the above, while the Board acknowledges that the Veteran’s PTSD results in significant occupational and social impairment, the Board finds that his PTSD has not resulted in total occupational and social impairment. Thus, an initial rating in excess of 70 percent is not warranted. In conclusion, an initial rating in excess of 70 percent for PTSD from July 28, 2014 is not warranted. As the preponderance of the evidence is against the claim, the claim must be denied. 38 U.S.C. § 5107(b); Gilbert, 1 Vet. App. 49. KELLI A. KORDICH Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. W. Kim, Counsel