Citation Nr: 19112942 Decision Date: 02/22/19 Archive Date: 02/21/19 DOCKET NO. 17-27 963 DATE: February 22, 2019 ORDER The appeal as to entitlement to service connection for left ear hearing loss, a right knee condition, a neck condition, bilateral ankle conditions, bilateral shoulder conditions, fibromyalgia, migraines, and lower extremity neuropathy and an initial compensable rating for right ear hearing loss is dismissed. Entitlement to service connection for obstructive sleep apnea, to include as secondary to service-connected posttraumatic stress disorder (PTSD), is denied. Entitlement to an initial rating in excess of 50 percent for PTSD is denied. FINDINGS OF FACT 1. In a November 2017 written response to the October 2017 Supplemental Statement of the Case, prior to the promulgation of a decision in the appeal, counsel gave notice of the Veteran’s desire to withdraw his pending appeal regarding service connection for left ear hearing loss, a right knee condition, a neck condition, bilateral ankle conditions, bilateral shoulder conditions, fibromyalgia, migraines, and lower extremity neuropathy and an initial compensable rating for right ear hearing loss. 2. The Veteran’s diagnosed obstructive sleep apnea is not shown to have manifested during active service; developed as a result of an established event, injury, or disease during active service; or to be due to or aggravated by service-connected PTSD. 3. The Veteran’s PTSD manifested by symptoms including hypervigilance, exaggerated startle response, sleep disturbance, anxiety, depression, irritation, suspiciousness, isolation, panic attacks weekly or less often, invasive thoughts, and difficulty in establishing and maintaining effective work and social relationships; these symptoms more nearly approximate the degree of occupational and social impairment contemplated by a 50 percent schedular rating. CONCLUSIONS OF LAW 1. The criteria for withdrawal of an appeal have been met in regard to the claims for service connection for left ear hearing loss, a right knee condition, a neck condition, bilateral ankle conditions, bilateral shoulder conditions, fibromyalgia, migraines, and lower extremity neuropathy and an initial compensable rating for right ear hearing loss. 38 U.S.C. § 7105(b)(2), (d)(5) (2012); 38 C.F.R. § 20.204 (2018). 2. The criteria for service connection for obstructive sleep apnea have not been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. §§ 3.303, 3.310 (2018). 3. The criteria are not met for an initial disability rating in excess of 50 percent for service-connected PTSD. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 3.321, 4.1-4.14, 4.130, Diagnostic Code 9411 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service in the United States Marine Corps from April 1992 to April 1996. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an August 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Waco, Texas. The Veteran submitted a notice of disagreement (NOD) in October 2015. A statement of the case (SOC) was issued in May 2017. The Veteran perfected a timely substantive appeal via VA Form 9 later in May 2017. Supplemental SOCs were issued in October 2017 and January 2018. The Board notes that the brief submitted by the Veteran’s counsel in December 2018 includes the issue of entitlement to increased ratings for the service-connected left knee conditions. In May 2017, the RO issued a rating decision granting entitlement to service connection for left knee chondromalacia evaluated as 10 percent disabling, left knee chondromalacia with subluxation evaluated as 20 percent disabling, and lumbar spine strain evaluated as 20 percent disabling, as of October 21, 2014. The Veteran submitted a NOD in June 2017 disputing the assigned evaluations. A SOC has not yet been issued for these claims. However, the NOD was acknowledged by the RO via written correspondence in June 2017. As the RO is processing the NOD, the Board declines jurisdiction over those issues at this time. See Manlincon v. West, 12 Vet. App. 238 (1999). Withdrawal of Appeal The Board may dismiss any appeal that fails to allege specific error of fact or law in the determination being appealed. 38 U.S.C. § 7105. An appeal may be withdrawn as to any or all issues involved in the appeal at any time before the Board promulgates a decision. 38 C.F.R. § 20.204. Withdrawal may be made by the Veteran or by his or her authorized representative. Id. In this case, via written correspondence in November 2017, the Veteran, through counsel, withdrew from appellate consideration the issue of entitlement to service connection for left ear hearing loss, a right knee condition, a neck condition, bilateral ankle conditions, bilateral shoulder conditions, fibromyalgia, migraines, and lower extremity neuropathy and an initial compensable rating for right ear hearing loss. Thus, there remain no allegations of errors of fact or law for appellate consideration as to these issues. Accordingly, the Board does not have jurisdiction to review the appeal of the issues of entitlement to service connection for left ear hearing loss, a right knee condition, a neck condition, bilateral ankle conditions, bilateral shoulder conditions, fibromyalgia, migraines, and lower extremity neuropathy and an initial compensable rating for right ear hearing loss. Service Connection Service connection may be granted for a disability resulting from injury suffered or disease contracted in the line of duty or for aggravation of preexisting injury suffered or disease contracted in the line of duty. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. In addition, service connection may be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes the disease was incurred in service. 38 C.F.R. § 3.303(d). In order to prevail on the issue of entitlement to service connection, there must be (1) evidence of a current disability; (2) evidence of in-service incurrence or aggravation of a disease or injury; and (3) evidence of a nexus between the claimed in-service disease or injury and the present disease or injury. Hickson v. West, 12 Vet. App. 247 (1999). A veteran seeking service connection must establish the existence of a disability and a connection between service and the disability. Boyer v. West, 210 F.3d 1351 (Fed. Cir. 2000). Service connection may also be established on a secondary basis for a disability which is proximately due to or the result of, or aggravated by, a service-connected disability. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show that a current disability exists and that the current disability was either proximately caused by or proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439 (1995). Whether lay evidence is competent and sufficient in a particular case is an issue of fact. Lay evidence can be competent and sufficient to establish a diagnosis when (1) a layperson is competent to identify the medical condition where the condition is simple, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). The Board has the authority to discount the weight and probity of evidence in light of its own inherent characteristics and its relationship to other evidence. Madden v. Gober, 125 F.3d 1477 (Fed. Cir. 1997). 1. Entitlement to service connection for obstructive sleep apnea. The Veteran contends that service connection is warranted for obstructive sleep apnea incurred as a result of his service. In an October 2014 Report of General Information, the Veteran expressed his intent to seek compensation for sleep apnea secondary to PTSD. He has also reported that symptoms of snoring and disrupted sleep first began in service. STRs are negative for diagnosis or treatment for obstructive sleep apnea. Upon examination in March 1996 in conjunction with his separation from the service, sleep apnea was not indicated. In an accompanying Report of Medical History, the Veteran reported asthma, pneumonia, coughing, and shortness of breath, but denied frequent trouble sleeping. Post-service medical records reflect a diagnosis of obstructive sleep apnea in August 2014. In May 2014, prior to the sleep study, the Veteran reported struggling to breath at night. A July 2015 VA examination regarding PTSD noted chronic sleep impairment. The Veteran also submitted a July 2015 statement from R.S.S., in which she described witnessing symptoms of a sleep disorder, including choking and gasping for air, for the past 15 years. In August 2015, the Veteran submitted a statement from a corpsman who served with him at Camp Pendleton. GEH wrote that the Veteran felt lightheaded and experienced breathing difficulties after a march. He was diagnosed with a respiratory infection and referred for further evaluation. GEH states that a sleep study was conducted and the Veteran was diagnosed with sleep apnea. Upon VA examination in October 2017, the examiner noted the diagnosis of sleep apnea in 2014. The Veteran reported longstanding problems with interrupted sleep, morning headaches, waking up at night gasping for air, and daytime somnolence dating back to around 1993/1994. He also reported the onset of nightmares related to the accidental shooting of a fellow Marine in 1995, which further contributed to his sleeping difficulty. The examiner indicated that review of STRs was negative for reported sleeping difficulties or diagnosed sleep apnea during active duty service. She stated that review of pertinent medical literature failed to support a causal association between PTSD and the development of obstructive sleep apnea. The well-known risk factors for obstructive sleep apnea include obesity, male gender, advancing age, and craniofacial/upper airway abnormalities. The examiner found that the Veteran’s weight/body mass index (BMI) at the time of separation from service in 1996 was 190lbs/26.5, compared to the weight/BMI at the time of his sleep study in 2014, which was 230/32. Her reference materials specifically noted that, “In both males and females, the strongest risk factor for OSA is obesity. The prevalence of OSA progressively increases as the BMI and associated markers (e.g., neck circumference, waist-to-hip ratio) increase [2,4]. In a prospective study of nearly 700 adults with four-year longitudinal follow-up, a 10 percent increase in weight was associated with a six-fold increase in risk of incident OSA.” This Veteran’s weight, therefore, is his most likely contributor to his sleep apnea according to the examiner. She stated that PTSD has not been shown to be a risk factor for development or worsening of the physical or anatomical upper airway obstruction associated with sleep apnea. Ultimately, she opined that it is less likely than not that the Veteran’s obstructive sleep apnea is proximately due to, the result of, or aggravated by, his PTSD. In a January 2018 addendum medical opinion, the examiner found that it was less likely than not that the obstructive sleep apnea was incurred in or caused by the Veteran’s service. The examiner noted that the Veteran was diagnosed with obstructive sleep apnea in 2015. He acknowledged the lay statements from July 2015 and August 2015, but stated that the testimonies were not consistent with the objective medical record evidence. The examiner opined that the sleep apnea is less likely than not (less than 50 percent probability) incurred in or caused by snoring and daytime sleepiness, respiratory/headaches complaints, or enlarged adenoids in service. Instead, he stated that the sleep apnea is at least as likely as not caused by the Veteran’s post-service weight gain/obesity, age and gender. He also stated that the sleep apnea is at least as likely as not aggravated beyond its natural progression by the weight gain/obesity. The examiner found no nexus between the Veteran’s snoring, daytime sleepiness, and respiratory/headaches complaints during service and his current obstructive sleep apnea. He explained that snoring and daytime sleepiness and respiratory/headache complaints are non-specific signs/symptoms which are not pathognomonic for obstructive sleep apnea. He noted that no in-service diagnosis of sleep apnea was found and that “frequent trouble sleeping” was marked “no” by the Veteran and the nose, mouth, and throat exams were marked “normal” by the provider in the March 1996 Reports of Medical History and Examination. He saw no indicating signs or symptoms consistent with obstructive sleep apnea or enlarged adenoids at the time of separation. The examiner reiterated that age and gender are listed as risk factors and obesity is listed as the major risk factor for sleep apnea upon review of the most current medical literature. He noted that, upon separation, the Veteran’s height was 5’11” and weight was 190 (calculated BMI is 26.5), while the 2014 sleep study documents his weight as 230 and BMI as 32. The examiner stated clearly that the etiology and aggravation of the Veteran’s obstructive sleep apnea is his post-service weight gain/obesity, age and gender and not snoring and daytime sleepiness, respiratory/headache complaints or enlarged adenoids in service. After careful consideration of the evidence of record, the Board finds that the preponderance of the evidence weighs against a finding that the Veteran’s current obstructive sleep apnea manifested during active service, developed as a result of an established event, injury, or disease during active service, or to be due to or aggravated by service-connected PTSD. The Board acknowledges the Veteran’s assertions that his sleep apnea is related to his military service, to include as secondary to PTSD. While lay persons are competent to provide opinions on some medical issues, determining the etiology of a complex condition such as sleep apnea falls outside the realm of common knowledge of a lay person. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011). In this regard, although the Veteran is competent to report his symptoms, any opinion regarding whether his currently diagnosed sleep apnea is etiologically related to his military service or PTSD requires medical expertise that he has not demonstrated. See Jandreau, 492 F.3d at 1376. Furthermore, these statements are in conflict with the Veteran’s March 1996 Report of Medical History which denied frequent trouble sleeping, as well as the March 1996 Report of Medical Examination which found no medical abnormalities related to sleep apnea. Although he reported shortness of breath, this was in conjunction with complaints of prior asthma and pneumonia. The March 1996 examiner noted no complaints at present. Accordingly, the Board assigns little probative value to the Veteran’s opinion that his sleep apnea is related to his military service or PTSD. The Board has also considered the lay statements from the Veteran’s acquaintances. In determining whether evidence submitted by a claimant is credible, VA may consider internal consistency, facial plausibility, and consistency with other evidence. See, e.g., Caluza v. Brown, 7 Vet. App. 498 (1995); Macarubbo v. Gober, 10 Vet. App. 388 (1997) (credibility of lay evidence can be affected and even impeached by inconsistent statements, internal inconsistency of statements, inconsistency with other evidence of record, facial implausibility, bad character, interest, bias, self-interest, malingering, desire for monetary gain, and witness demeanor). Notably, the August 2015 statement of GEH indicated that the Veteran underwent a sleep study during service and was diagnosed with sleep apnea in service. There is no indication of a sleep study or related diagnosis in the STRs. It is well-established that the mere absence of contemporaneous medical documentation of treatment does not alone render lay testimony not credible. Buchanan v. Nicholson, 451 F. 3d 1331, 1336 (Fed. Cir. 2006). However, the Board affords this statement no probative value as it is inconsistent with the clinical evidence of record and with the Veteran’s own reports of his medical history. See, e.g., Curry v. Brown, 7 Vet. App. 59, 68 (1994) (noting that contemporaneous evidence has greater probative value than history as reported by a veteran). STRs reflect complaints of cough and respiratory issues, but there was no report of a sleep study during service or mention of such study upon the Veteran’s separation from service. Indeed, the Veteran denied trouble sleeping and no sleep apnea defects were found during examination in March 1996. Private treatment records are silent as to the condition for many years following service and reflect good health generally. While GEH is competent to report a diagnosis based upon his training as a corpsman, his statement does not contain a direct diagnosis, but rather a third-party description of a sleep study and resulting diagnosis. Ultimately, the Board does not find his statement credible in light of the conflicting objective evidence of record. Conversely, RSS is credible in her statements describing the Veteran’s history of disrupted sleep. However, as a lay person, she is not competent to provide an opinion regarding the etiology of a complex condition such as sleep apnea, as this falls outside the realm of common knowledge of a lay person. See Kahana, 24 Vet. App. at 435. Additionally, the Board notes that she reported witnessing the Veteran’s symptoms since 2000, which supports the longevity of such symptoms but does not relate the condition to his service, which ended in 1996. Thus, while the Board has considered the lay statements of record, they are outweighed in probative value by the October 2017 and January 2018 medical opinions which were based upon comprehensive review of the Veteran’s claims file and supported by detailed rationales. See Jandreau, 492 F.3d at 1376 (noting “the Board retains discretion to make credibility determinations and otherwise weigh the evidence submitted”). The VA examination reports are persuasive in their consistent findings that there was no medical evidence of obstructive sleep apnea during active service, no credible evidence of associated symptoms manifested during active service, and no evidence that sleep apnea was due to or aggravated by the service-connected PTSD. The examiners reviewed the claims file, to include lay statements, records over the course of the Veteran’s active service period, and reports of manifest symptoms. They also reviewed current medical literature regarding the etiology of sleep apnea, including any connection to psychological conditions. Significantly, the VA medical opinions attributed the sleep apnea to the Veteran’s weight gain and other risk factors such as age and gender. These findings are consistent with a May 2014 private treatment note which suggested a link between his weight and sleep apnea. Thus, the Board finds that the collective opinions of the VA examiners are dispositive of the nexus issue, on both direct and secondary theories of entitlement. The Board also finds that the examiners adequately considered the evidence of record as to symptom manifestation. Dalton v. Nicholson, 21 Vet. App. 23 (2007). The January 2018 examiner specifically acknowledged the lay statements from July 2015 and August 2015, but explained that he found them to be inconsistent with the Veteran’s medical history. He also found no nexus between the Veteran’s reports of snoring, daytime sleepiness, and respiratory/headaches complaints during service and his current obstructive sleep apnea. Therefore, as the most probative evidence of record does not reflect a nexus between the Veteran’s current sleep apnea diagnosis and his service or his service-connected PTSD, the claim for service connection must be denied, on both direct and secondary theories of entitlement. In reaching the above conclusions, the Board has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the Veteran’s claims, that doctrine is not applicable. See 38 U.S.C. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Increased Rating Disability evaluations are determined by the application of VA’s Schedule for Rating Disabilities (Rating Schedule), found in 38 C.F.R. Part 4. The basis of disability evaluations is the ability of the body as a whole to function under the ordinary conditions of daily life, including employment. 38 C.F.R. § 4.10. 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 the residual conditions in civil occupations. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321(a), 4.1. Disabilities must be reviewed in relation to their history. 38 C.F.R. § 4.1. Other applicable, general policy considerations are: interpreting reports of examination in light of the whole recorded history and reconciling the various reports into a consistent picture so that the current rating may accurately reflect the elements of disability; resolving any reasonable doubt regarding the degree of disability in favor of the claimant; where there is a question as to which of two evaluations apply, assigning a higher of the two where the disability picture more nearly approximates the criteria for the next higher rating; and evaluating functional impairment on the basis of lack of usefulness, and the effects of the disabilities upon the person’s ordinary activity. See Schafrath v. Derwinski, 1 Vet. App. 589 (1991); 38 C.F.R. § 4.2, 4.3, 4.7, 4.10. For an initial rating claim, consideration will be given to “staged ratings” since service connection was made effective. See Fenderson v. West, 12 Vet. App. 119 (1999). In other words, where the evidence contains factual findings demonstrating distinct time periods in which the service-connected disability exhibited diverse symptoms meeting the criteria for different ratings during the course of the appeal, the assignment of a staged rating would be necessary. Id. When there is a question as to which of two ratings to apply, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating; otherwise, the lower rating shall be assigned. 38 C.F.R. § 4.7. The Veteran’s PTSD is evaluated under 38 C.F.R. § 4.130, Diagnostic Code 9411. Under the General Rating Formula For Mental Disorders, to include PTSD, a 50 percent evaluation 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 (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 evaluation is warranted where there is 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; intermittently illogical, obscure, or irrelevant speech; 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 evaluation is assignable where 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); and disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. Id. Consideration is given to the frequency, severity, and duration of psychiatric symptoms, the length of remission, and the Veteran’s capacity for adjustment during periods of remission. An evaluation shall be assigned based on all the evidence of record that bears on occupational and social impairment, rather than solely on the examiner’s assessment of the level of disability at the moment of the examination. See 38 C.F.R. § 4.126 (2018). Furthermore, when evaluating the level of disability arising from a mental disorder, the rating agency will consider the extent of social impairment, but shall not assign an evaluation solely on the basis of social impairment. Id. It is necessary to evaluate a disability from the point of view of the Veteran working or seeking work. 38 C.F.R. § 4.2. The symptoms associated with the psychiatric rating criteria are not intended to constitute exhaustive lists, but rather serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating. Mauerhan v. Principi, 16 Vet. App. 436, 443 (2002). Thus, the Board will consider whether “the evidence demonstrates that a claimant suffers symptoms or effects that cause occupational or social impairment equivalent to what would be caused by the symptoms listed in the diagnostic code,” and, if so, the “equivalent rating will be assigned.” Id. 2. Entitlement to an initial rating in excess of 50 percent for posttraumatic stress disorder. The Veteran contends that the 50 percent rating assigned for his service-connected PTSD does not adequately reflect the severity of his disability. He initially submitted a claim of entitlement to service connection for PTSD, depression, and anxiety in October 2014. In a June 2015 statement, he described witnessing the death of a fellow Marine and other stressors in service. He stated that he sought treatment following service and suppressed his thoughts while isolating himself. He underwent VA examination in July 2015. The examiner diagnosed PTSD and found no other mental health conditions present. The Veteran described his divorce in 2008 and his continuing relationships with his daughter and step-daughter. He stated that he was in regular contact with his mother and had contact with his half-siblings. He also stayed connected with military buddies through social media. The Veteran felt that he did not have close friends, just acquaintances. He described staying home to watch TV when not at work, although he occasionally visited a local casino to gamble. He was employed since 2010 as a logistics coordinator and reported getting along with his supervisors and co-workers. He reported symptoms of hypervigilance, exaggerated startle response, and sleep disturbance. The examiner found symptoms of anxiety, panic attacks weekly or less often, difficulty in establishing and maintaining effective work and social relationships, and obsessional rituals which interfere with routine activities. He stated that the PTSD caused 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. An August 2015 rating decision granted entitlement to service connection for PTSD with an evaluation of 50 percent effective October 21, 2014. The Veteran submitted a NOD in October 2015 contesting the assigned disability rating. He was scheduled for a new VA mental health examination but failed to appear. In his May 2017 VA Form 9, he requested that the examination be rescheduled. In October 2017, the Veteran underwent further VA examination in conjunction with his claim. The examiner diagnosed PTSD and found no other mental health conditions present. The Veteran reported that his mother and father were deceased and his daughter lived with his ex-wife, although he saw her frequently. He lived alone and was not dating seriously. He stated that he distanced himself from others socially as he grew older. The Veteran continued to report contact with military buddies through social media. He recently went on a cruise with programming for veterans, which was his first vacation in four years. He felt that it connected him with other veterans and he was thinking of going again in the future. The Veteran was employed with the same employer since 2010 and being promoted to oversee more than the five workers for which he was currently responsible. He stated that he got along well with his supervisees and his managers. The Veteran denied any mental health treatment. He described depression, irritation, and invasive thoughts. The examiner noted that the Veteran was appropriately dressed and groomed. Psychomotor behavior was normal. There were no gross deficits in short- or long-term memory evidenced. His thought processes were coherent and goal-directed. No delusions, hallucinations, or obsessions were present. The examiner reported the Veteran’s PTSD symptoms as anxiety, suspiciousness, chronic sleep impairment, and difficulty in establishing and maintaining effective work and social relationships. He stated that the PTSD caused occupational and social impairment with reduced reliability and productivity. The examiner found no evidence that the Veteran’s mental health had deteriorated. He does not experience conflict with others, handles his limited family responsibilities competently, and gets along well at his job, where he is a supervisor. He has become withdrawn since service, and has neglected the non-work part of his life for years, rarely dating and not opening up to others. Otherwise, the examiner found that he is a responsible and fairly high-functioning individual. After thorough consideration of the evidence, the Board finds that the Veteran’s symptoms overall more closely approximate the criteria for the assigned 50 percent disability rating, but no higher, since the date of the claim. See 38 C.F.R. § 4.130, Diagnostic Code 9411. Collectively, the VA examination reports, treatment records, and Veteran’s lay statements do not reflect findings of a severity to warrant a 70 percent rating. The evidence indicates that he was normally oriented and cooperative, albeit experiencing intrusive thoughts, irritation, and suspiciousness. He was appropriately groomed and dressed, and had appropriate affect, normal speech, and intact judgment throughout the period on appeal. While the evidence reflects bouts of anxiety, panic attacks, and isolation, there is no evidence of intermittently illogical, obscure, or irrelevant speech; spatial disorientation; neglect of personal appearance and hygiene; inability to establish or maintain social or work relationships; or near-continuous panic or depression which interfered with routine ability to function. During this time, the Veteran reported social isolation, but also indicated good relationships with his daughter and step-daughter. He poured himself into work and did not date or seek mental health treatment. He went out to the local casino to gamble on occasion and took part in a cruise with other veterans. The July 2015 VA examiner found that the PTSD caused occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although the Veteran generally functioning satisfactorily, with normal routine behavior, self-care and conversation. The October 2017 VA examiner found functioning manifested by occupational and social impairment with reduced reliability and productivity. Thus, the medical evidence shows that the Veteran is capable of maintaining relationships with his family members and participating in activities with other veterans. Medical professionals found him to be appropriately dressed and able to perform all activities of daily living. The Veteran has been employed with the same company since 2010 and reports good relationships with his managers as well as those he supervises. He is performing at a high level and advancing within the company. Thus, it is not shown that the PTSD is manifested by social and occupational impairment in most areas or totally so as to warrant a 70 or 100 percent rating. The Board has reviewed the December 2018 brief from Veteran’s counsel, which asserts, in part, that a 70 percent evaluation is warranted based upon symptoms of obsessional rituals which interfere with routine activities, difficulty in adapting to stressful circumstances, and the inability to establish and maintain effective relationships. However, neither VA examination report indicated the presence of difficulty in adapting to stressful circumstances or the inability to establish and maintain effective relationships. Indeed, the October 2017 examiner found the Veteran to be responsible and high-functioning. The Veteran reported experiencing stress at work regarding his performance and deadlines. He also described being direct with his co-workers, which he said worked well. The fact that he was placed in a supervisory position over five employees and was being considered for a promotion with additional supervisory obligations suggests that the Veteran has adapted well despite any workplace stress. In regard to establishing and maintaining effective relationships, the examiners indicated that he had difficulty, but was not unable to do so entirely. As described above, the Veteran reported good relationships at work. He also maintained good relationships with family and other veterans. The evidence shows that he struggled with dating and was socially isolated. These difficulties are reflected with a 50 percent disability rating. Finally, the Board notes that the July 2015 examiner indicated the presence of obsessional rituals. It is unclear to the Board why the examiner marked this symptom, as the extensive history contained in the examination report did not include the Veteran’s description of any obsessional rituals interfering with routine activities. Subsequently, the October 2017 examiner found no evidence of obsessions. The Board reiterates that the symptoms noted in the rating criteria are not intended to be an exhaustive list, but are examples of the types and severity of symptoms that indicate a certain level of disability. Although the evidence reflects some symptoms indicative of higher disability ratings, a rating is not to be assigned solely on the presence or absence of particular symptoms but; rather, with consideration being given to the frequency, severity, and duration of such symptoms. See Vazquez–Claudio v. Shinseki, 713 F.3d 112, 117 (Fed. Cir. 2013). Thus, the Board finds that the Veteran’s level of impairment is more closely analogous to that contemplated by the 50 percent rating. The Veteran is competent to provide evidence about his disability; for example, he is competent to describe symptoms related to his acquired psychiatric condition. See Layno v. Brown, 6 Vet. App. 465 (1994). He is also credible to the extent that he sincerely believes he is entitled to a higher rating. However, he is not competent to identify a specific level of disability according to the appropriate Diagnostic Code. Competent evidence concerning the nature and extent of the Veteran’s mental disorder was provided by the VA examiners who have interviewed and evaluated him during the current appeal. The medical findings as provided in the various VA examination reports directly address the criteria under which this disability is evaluated. Thus, the competent lay evidence is outweighed by the competent medical evidence that evaluates the true extent of his disabilities. The Board has considered whether any other potentially relevant Diagnostic Codes would yield higher ratings for the Veteran’s PTSD. However, when a condition is specifically listed in the Rating Schedule, it may not be rated by analogy. See Copeland v. McDonald, 27 Vet. App. 333, 338 (2015) (pes planus is specifically rated under Diagnostic Code 5276; hence an analogous rating under Diagnostic Code 5284 was not permitted). Thus, Diagnostic Code 9411 is the most appropriate in light of the PTSD diagnosis and symptoms. Taking into account the competent and probative evidence of record, the Board finds that the collective medical and lay evidence does not indicate that the Veteran’s PTSD meets the rating criteria for an evaluation in excess of 50 percent during the period on appeal. The effects of the Veteran’s psychiatric symptoms are not described to be of a type, frequency, and severity in accord with the impairment contemplated by the criteria for a schedular rating higher than 50 percent disabling. See 38 C.F.R. § 4.130, Diagnostic Code 9411. Accordingly, the Veteran’s claim for an increased rating is denied. In reaching this conclusion, the Board has considered the applicability of the benefit-of-the-doubt doctrine. However, as the preponderance of the evidence is against the Veteran’s claim, that doctrine is not applicable. See 38 U.S.C § 5107(b); 38 C.F.R. §§ 3.102, 4.3; Gilbert, 1 Vet. App. at 53. The Veteran has not raised any other issues with respect to the increased rating claim for his PTSD, nor have any other assertions been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366, 369-70 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). TANYA SMITH Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Jamison, Elizabeth G.