Citation Nr: 21002170 Decision Date: 01/12/21 Archive Date: 01/12/21 DOCKET NO. 11-22 049 DATE: January 12, 2021 ORDER An effective date, earlier than January 26, 2010, for the grant of service connection for posttraumatic stress disorder (PTSD), is denied. An initial rating of 50 percent for PTSD from January 26, 2010 to September 30, 2015 and a 70 percent rating thereafter, is denied. An initial compensable rating for bilateral hearing loss is denied. FINDINGS OF FACT 1. The Veteran’s claim for service connection for PTSD was received on January 26, 2010. 2. No formal or informal application to assert a claim for service connection for PTSD was received prior to January 26, 2010. 3. For the period from January 26, 2010 to September 30, 2015, the Veteran’s PTSD was not shown to cause occupational impairment with deficiencies in most areas, or worse. 4. At no time has the Veteran’s PTSD been shown to cause total occupational and total social impairment. 5. At worse, the Veteran’s bilateral hearing loss has been characterized by numeric designation Level III in the right ear and a Level II in the left ear. CONCLUSIONS OF LAW 1. The criteria for an effective date earlier than January 26, 2010, for the grant of service connection for PTSD, have not been met. 38 U.S.C. § 5110; 38 C.F.R. §§ 3.156, 3.400. 2. From January 26, 2010 to September 30, 2015, the criteria for a rating in excess of 50 percent for PTSD have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.321, 4.1, 4.3, 4.7, 4.21, 4.126, 4.130, Diagnostic Code 9411. 3. The criteria for a rating in excess of 70 percent for PTSD have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.321, 4.1, 4.3, 4.7, 4.21, 4.126, 4.130, Diagnostic Code 9411. 4. The criteria for a compensable rating for bilateral hearing loss have not been met. 38 U.S.C. § 1155; 5107; 38 C.F.R. §§ 3.321, 4.1, 4.10, 4.85, 4.86, Diagnostic Code 6100. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 1966 to June 1969. He provided testimony at a July 2016 Board hearing for his increased rating claim for PTSD. However, the Veterans Law Judge (VLJ) who conducted the July 2016 Board hearing is no longer employed by the Board. In February 2017, the Board sent the Veteran a letter informing him of this situation and asked him if he wished to attend another hearing before a VLJ, who would render a decision in his case. The Veteran requested a new Board Hearing. The Veteran provided testimony before the undersigned VLJ at an August 2018 Board hearing. This appeal was previously before the Board in June 2020. The Board remanded the Veteran’s increased rating claim for PTSD because medical evidence submitted after the August 2018 Board hearing showed that a medical professional opined that the Veteran was totally and permanently disabled due to PTSD. A new VA examination was ordered to ascertain the current severity of his PTSD. The Veteran’s earlier effective date claim for PTSD was remanded because it was found to be inextricably intertwined with the increased rating claim for PTSD. The Veteran’s increased rating claim for bilateral hearing loss was remanded to afford the Veteran a new VA examination because he asserted that his hearing loss had worsened. The Veteran was afforded a VA examination for PTSD and bilateral hearing loss, to ascertain the severity of each respective disability in July 2020. The Veteran has not challenged the sufficiency of either examination. As such, the Board finds that there has been substantial compliance as to all of the June 2020 Board remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998). 1. An effective date prior to January 26, 2010, for the grant of service connection for PTSD is denied. The Veteran asserts that he is entitled to an effective date earlier than January 26, 2010 for his PTSD. Specifically, he asserts that he was diagnosed with severe PTSD in July 1998. See NOD dated December 28, 2015 and Form 9 dated February 16, 2015. The general rule for earlier effective dates for service connection provides that if a claim for disability compensation is received within one year after separation from service, the effective date of entitlement will be either the day following separation or the date entitlement arose. 38 U.S.C. § 5110 (b)(1). Here, there is no contention that a claim was received within a year of separation from service. If a claim is not received within a year of separation, VA regulations provide that the effective date is the date of receipt of the claim or the date entitlement arose, whichever is later. 38 C.F.R. § 3.400. A specific claim in the form prescribed by the Secretary of VA must be filed in order for benefits to be paid to any individual under the laws administered by the VA. 38 U.S.C. § 5101 (a). A “claim” is defined broadly to include a formal or informal communication in writing requesting a determination of entitlement or evidencing a belief in entitlement to a benefit. 38 C.F.R. § 3.1 (p); Brannon v. West, 12 Vet. App. 32, 34-5 (1998). Any communication indicating an intent to apply for a benefit under the laws administered by VA may be considered an informal claim provided it identifies, but not necessarily with specificity, the benefit sought. See 38 C.F.R. § 3.155 (a). To determine when a claim was received, the Board must review all communications in the claims file that may be construed as an application or claim. See Quarles v. Derwinski, 3 Vet. App. 129, 134 (1992). VA received the Veteran’s claim for service connection for PTSD on January 26, 2010. As such, the relevant period on appeal begins on January 26, 2010. The Board notes that this issue was previously before the Board in July 2014. However, the Veteran expressed his desire to withdraw his earlier effective date claim from appellate review at a February 2012 pre-conference hearing. Based on the Veteran’s decision to withdraw the claim, the July 2014 Board decision dismissed the claim because it no longer had jurisdiction. See 38 U.S.C. § 7105(d). The Board acknowledges that the June 2020 Board decision characterized the earlier effective date claim, as an earlier effective date for the 70 percent evaluation for PTSD. This characterization appears to be part of a staged rating claim because his 70 percent rating is effective, September 30, 2015, which is about five years after the relevant period on appeal began. The issue of whether the Veteran is entitled to a 70 percent rating, prior to September 30, 2015, will be addressed in the increased rating for PTSD section of this decision. Here, the Veteran’s claim for an earlier effective date for PTSD has never been adjudicated by the Board on its merits and a decision regarding this issue has not become final because his appeal has remained on appellate status since January 2010. Although he withdrew the earlier effective date claim at a February 2012 pre-conference hearing, he subsequently indicated in his December 2015 NOD and February 2016 Form 9 that his PTSD should be granted an effective date in July 1998 because that is when he was diagnosed with PTSD. Based on the Veteran’s explicit disagreement with the assigned effective date in his December 2015 NOD and February 2016 Form 9, the Board will adjudicate whether the Veteran is entitled to an earlier effective date for PTSD, prior to January 26, 2010. After a careful review of the Veteran’s post-service treatment records, it does show a diagnosis for PTSD in 1998. See Medical Treatment Record – Government Facility received November 23, 1998. A February 1999 rating decision denied the Veteran’s service connection claim for PTSD because his diagnosis was not confirmed and there was no evidence or statement of possible stressor events. The Veteran submitted new evidence showing a stressor event in October 1999. See Buddy Statement received October 12, 1999. A subsequent July 2000 rating decision denied the Veteran’s service connection claim because there was no evidence of a confirmed diagnosis and the buddy statement was found to be inadequate to establish a stressor event. The Veteran did not disagree with the July 2000 rating decision and it thereby became final. See 38 U.S.C. §§ 5108, 7105; 38 C.F.R. §§ 3.104, 3.156, 20.302, 20.1103. VA received the Veteran’s claim for service connection for PTSD on January 26, 2010; there was no formal or informal application for service connection for PTSD between July 2000 and January 2010. An August 2010 rating decision granted service connection for PTSD and assigned an effective date of January 26, 2010. The United States Court of Appeals for Veterans Claims (Court) held in Sears v. Principi, 16 Vet. App. 244, 248 (2002) that “[t]he statutory framework simply does not allow for the Board to reach back to the date of the original claim as a possible effective date for an award of service-connected benefits that is predicated upon a reopened claim.” In order for the Veteran to be awarded an effective date based on an earlier claim, he would have to show clear and unmistakable error (CUE) in the prior denial of the claim. See Flash v. Brown, 8 Vet. App. 332, 340 (1995). Here, there has been no assertion of clear and unmistakable error in the July 2000 rating decision. As such, the Board concludes that there is no basis to overcome the finality of the July 2000 rating decision. The United States Court of Appeals for the Federal Circuit has determined that, even when a Veteran has a claim to reopen, “he cannot obtain an effective date earlier than the reopened claim’s application date.” Leonard v. Nicholson, 405 F.3d 1333, 1336-37 (Fed. Cir., 2005). Because the July 2000 rating decision is final, the effective date for service connection for PTSD was appropriately assigned as of the Veteran’s claim to reopen; which VA received on January 24, 2010. See Ingram v. Nicholson, 21 Vet. App. 232, 249, 255 (2007). Accordingly, the claim for an effective date earlier than January 26, 2010, for the grant of service connection for PTSD is denied. 2. An initial rating of 50 percent for PTSD from January 26, 2010 to September 30, 2015 and a 70 percent rating thereafter, is denied. The Veteran asserts that he is entitled to an initial rating of 70 percent for PTSD. See Form 9 dated August 5, 2011. He also asserts that he is entitled to a total schedular rating prior to July 30, 2020, the date he was assigned a 100 percent rating for PTSD. This issue was previously before the Board in June 2020. The Board remanded the increased rating claim for PTSD because medical evidence submitted after the August 2018 Board hearing showed that a medical professional opined that the Veteran was totally and permanently disabled due to PTSD. The Veteran was afforded a VA examination in July 2020 to ascertain the current severity of his PTSD. As such, the Board finds that there has been substantial compliance as to all of the June 2020 Board remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998). VA received the Veteran’s service connection claim for PTSD on January 26, 2010. An August 2010 rating decision granted the Veteran’s claim and assigned an initial 30 percent disability rating, effective January 26, 2010. The Veteran disagreed with the assigned rating and a subsequent October 2011 rating decision increased his initial rating for PTSD to 50 percent, effective January 26, 2010. The Veteran continued to disagree with the assigned rating. His disability rating was subsequently increased to 70 percent, from September 30, 2015, forward. After the July 24, 2020 VA examination, the Veteran’s disability rating was increased to 100 percent, effective July 24, 2020. As such, the Board will adjudicate whether the Veteran is entitled to an initial rating in excess of 50 percent from January 26, 2010 to September 30, 2015; and whether he is entitled to a 100 percent rating from September 30, 2015, forward. Under the General Rating Formula for Mental Disorders, a 50 percent rating is assigned when a Veteran’s PTSD causes 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-term 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; or difficulty in establishing and maintaining effective work and social relationships. 38 C.F.R. § 4.130, Diagnostic Code 9411. A 70 percent evaluation is assigned when a Veteran’s PTSD causes occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work like setting); or an inability to establish and maintain effective relationships. Id. A 100 percent rating is assigned when a Veteran’s PTSD causes total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; danger of hurting self or others; intermittent inability to perform activities of living (including maintenance of minimal hygiene); disorientation to time or place; or, memory loss for names of close relatives, occupation, or own name. Id. When rating a mental disorder, VA must consider the frequency, severity, and duration of the Veteran’s psychiatric symptoms, the length of remissions, and the Veteran’s capacity for adjustment during periods of remission. The rating agency must assign a rating 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. When rating the level of disability from a mental disorder, the rating agency must consider the extent of social impairment, but cannot assign a rating solely on the basis of social impairment. 38 C.F.R. § 4.126. Furthermore, the specified factors for each incremental rating are examples, rather than requirements, for a particular rating. The Board will not limit its analysis solely to whether the Veteran exhibited the symptoms listed in the rating criteria. Mauerhan v. Principi, 16 Vet. App. 436 (2002). Indeed, the symptoms listed under § 4.130 are not intended to serve as an exhaustive list of the symptoms that VA may consider but as examples of the type of degree of symptoms, or the effects, that would warrant a particular rating. Mauerhan, 16 Vet. App. at 442 (2002). The Veteran’s actual symptomatology, and resulting social and occupational impairment, will be the primary focus when assigning a disability rating for a mental disorder, and the Veteran may qualify for a particular rating by demonstrating the particular symptoms associated with that percentage, or other symptoms of similar severity, frequency, and duration. Vazquez Claudio v. Shinseki, 713 F.3d 112, 116 (Fed. Cir. 2013). The Board notes that in addition to the Veteran’s service-connected PTSD, he has also been diagnosed with major depressive disorder (MDD). See January 2010 VA mental evaluation report. Service-connection has not been established for MDD and it is unclear from this evaluation whether or not the symptoms attributed to this disorder are intertwined with his PTSD. When it is not possible to separate the effects of the service-connected disability from a nonservice-connected disability, such signs and symptoms shall be attributed to the service-connected disability. See 38 C.F.R. § 3.102 (2008); Mittleider v. West, 11 Vet. App. 181 (1998). Further, at the July 2010 VA examination, the VA examiner noted that although the Veteran described having some depressive symptoms associated with his PTSD, he did not meet the DSM-IV criteria for an independent or a major depressive disorder at that time. Accordingly, the Board will consider the psychiatric symptoms as depicted by the evidence as a whole in rating the service-connected PTSD unless clearly attributed to the other nonservice connected disorders. The competent evidence of record, to include the Veteran’s treatment records and VA examination reports do not establish findings consistent with an initial rating in excess of 50 percent prior to September 30, 2015. A review of the Veteran’s post-service treatment records during this period on appeal show that he was receiving ongoing psychiatric treatment from VA. His treatment record documented that the Veteran had trouble dealing with anger, flashbacks, and nightmares. For example, the Veteran noted in a January 2010 Mental Health Assessment, that he had an inability to control his anger, which has resulted in a number of problems, including both socially and occupationally. See VA Treatment Record dated January 28, 2010. He also reported that he spent most of his time alone and that he had no friends. Id. Based on this discussion with the Veteran, the VA medical professional noted that he experienced recurring flashbacks, memories, thoughts, and images of the traumatic events he encountered in service, as well as disturbing dreams surrounding his Vietnam experiences. The VA medical professional also noted that the Veteran experienced difficulty falling or staying asleep, and reportedly only got approximately three hours of sleep a night. The Veteran also described feeling extremely suspicious and distrustful of others, as well as experiencing an increased startle response. Although the Veteran reported very isolating behavior, he did report that he had some interaction with his children and grandchildren. See VA Treatment Record dated April 6, 2011. Further, he reported that his only enjoyment came from spending time with his grandchildren. See VA Treatment Record dated December 15, 2010. The Veteran was afforded a VA examination in July 2010. The Veteran denied any history of suicidal thoughts or attempts, but recalled experiencing anger issues a few weeks prior wherein he developed very aggressive thoughts that took him two weeks to calm down from. He also denied a history of homicidal ideation or attempts, but did note that he was prone to outbursts of anger. He noted that while seasonal deer hunting is popular in his town, he could no longer participate in this activity because being around people with guns agitated him and made him defensive. The Veteran also reported experiencing symptoms of anger and irritability that were triggered by the smallest events, and specifically recalled a particular episode where he threatened a co-worker of his for cutting in front of him while driving. According to the Veteran, once he cooled down, he apologized to his co-worker and tried to repair the situation because he understood that the co-worker had not done anything wrong. The Veteran attributed the intensity of his anger the past few months to his PTSD therapy sessions which had triggered memories of Vietnam. The Veteran described the following symptoms: difficulty concentrating; short term memory impairment, impaired sleep, hypervigilance, and increased startle response. The examiner noted that the Veteran did not have signs of inappropriate behavior, impairment of thought process or communication, delusional thoughts, flattened affect, impaired impulse control, or hallucinations and his insight and judgment were shown to be fair. In an April 2011 letter, the Veteran’s treating psychiatrist at VA, noted that he had been compliant with his treatment, but continued to suffer from nightmares, flashbacks, emotional numbing, an increased startle reflex, hyperarousal, high levels of anxiety, memory disturbance and intrusive thoughts. According to the treating psychiatrist, the Veteran was socially, occupationally, and interpersonally impaired due to the chronic nature of his symptoms and has been written up at work several times due to his inappropriate behavior. The Veteran was afforded a second VA psychiatric examination in August 2011, at which he denied experiencing any suicidal ideation or attempts, and noted that even at times when he feels as though he had given up and lost hope, these thoughts evaporate as soon as he sees his granddaughter. He reported that he had two prior marriages, with two divorces. He had a third relationship without a marriage, from which he has two children, and he reported trying to maintain a relationship with her because of the children. He reported that he had been a mail carrier since 1984, but had been fired four times and had to fight to get his job back, the last instance having occurred in 1991. He stated that he hit various people at work, to include supervisors, because when somebody touched him without announcing their presence, he tended to hit them. He reported that during his employment hearings, they always found that somebody grabbed him before they were hit. The examiner noted the following symptoms; anxiety, suspiciousness, panic attacks more than once a week, chronic sleep impairment, mild memory loss, disturbances of motivation and mood, and difficulty in establishing and maintaining effective work and social relationships. After a review of the Veteran’s claims file and an in-person examination, the examiner found that the best summary of the Veteran’s level of impairment was occupational and social impairment with reduced reliability and productivity, a finding consistent with a 50 percent rating. The Veteran’s post-service treatment records after the August 2011 VA examination show that he was still receiving mental health treatment though VA and was still socially isolating and was emotionally withdrawn; however, he did report recently losing a good friend in 2013 and reported that he was still trying to spend time with his grandchildren. See VA Treatment Records dated January 3, 2013 and September 23, 2014. Here, the Board acknowledges that the Veteran’s PTSD caused him both social and occupational impairment prior to September 30, 2015. However, the weight of the evidence is against a finding that the Veteran’s psychiatric symptomatology caused occupational and social impairment, with deficiencies in most areas, nor has he shown an inability to establish and maintain effective relationships. When viewing the disability picture as a whole, the evidence of record does not warrant a rating in excess of 50 percent prior to September 30, 2015. During that time, the Veteran showed difficulty establishing and maintaining effective work and social relationships. He reported that he was socially isolative and emotionally withdrawn, with no friends. He also reported significant trouble at work, especially when someone touched him without announcing themselves. However, the Veteran reported that he maintained a relationship with the mother of his children and enjoyed spending time with his grandchildren. Moreover, he had been able to maintain his employment at the U.S. Postal Service since 1984, albeit with some incidents as discussed. For example, he described a situation in which he reacted very impulsively, threatening a co-worker for cutting in front of him while driving; but he later apologized to his co-worker and tried to repair the situation because he understood that the co-worker had not done anything wrong. These examples show that the Veteran’s PTSD has negatively impacted his relationships and caused difficulty with them; but it did not suggest an inability to maintain and establish effective relationships as would be expected with a 70 percent rating. The Board recognizes that the Veteran has been noted to have additional symptomatology that is not enumerated in the rating schedule, including anger, flashbacks, feelings of distrust, and an increased startle response. See Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). However, the Board nevertheless finds that the overall symptomatology warrants a 50 percent rating for the period from January 26, 2010 to September 30, 2015. During, that time, the Veteran did not show the following symptoms associated with a 70 percent rating: suicidal ideation, obsessional rituals, speech intermittently illogical, impaired impulse control, spatial disorientation, neglect of personal appearance, difficulty in adapting to stressful circumstances, or an inability to establish and maintain effective relationships. The Veteran was shown to have panic attacks more than once a week, which is contemplated by a 50 percent rating; however, it did not rise to the level of near continuous panic, which is contemplated by a 70 percent rating. The Board finds that the Veteran’s unenumerated symptoms, in conjunction with the enumerated symptoms for a 50 percent rating under Diagnostic Code 9411 support a finding of occupational and social impairment with reduced reliability and productivity. Further, there has been no showing that the Veteran’s PTSD symptoms caused total social and occupational impairment during this period on appeal, as shown by his ability to remain employed. Accordingly, an initial rating in excess of 50 percent for PTSD, from January 26, 2010 to September 30, 2015, is denied. The Veteran was afforded a VA examination in September 2015, at which he reported continuing to work at the Post Office, feeling that he needed to keep working to prevent himself from becoming totally unstable in terms of his physical, mental, and emotional health. The Veteran reported having frequent passive suicidal ideation; often telling himself, “I don’t care if I go (die). Why am I here? I don’t want to be here anymore.” He reported that he was extremely reactive and had trouble interacting with co-workers, supervisors, and customers, directly telling them to stay away from him. He also reported angry outbursts, sleep disturbances, frequent panic attacks, flashbacks, and trouble with concentration, focus, and memory. After a review of the Veteran’s claims file and an in-person examination, the examiner found that the best summary of the Veteran’s level of impairment was occupational and social impairment with deficiencies in most areas, a finding consistent with a 70 percent rating. The Veteran reported that he was still in a “non-marriage” relationship since 1985, with the mother of his children, but noted that they never lived together. He stated that they have never lived together because they cannot be together for longer than an hour or so, due to his PTSD related anger, trust, and detachment issues. He denied having any friends, but stated that his grandchildren do bring some positive emotions of love and happiness to his life. The examiner reported the following symptoms: depressed mood, anxiety, suspiciousness, near-continuous panic, chronic sleep impairment, mild memory loss, disturbances of motivation and mood, difficulty in adapting to stressful circumstances, inability to establish and maintain effective relationships, and suicidal ideation. The examiner noted that there was no evidence of impairment of thought process or communication or evidence of delusions or hallucinations. The examiner also noted that the Veteran had the ability to maintain minimal personal hygiene and other basic activities of daily living and was oriented to time or place. The examiner acknowledged the Veteran’s short-term memory problems, but did not note memory loss for names of close relatives, occupation, or own name. The examiner explained that although the Veteran did struggle with frequent passive suicidal ideation, he denied any current active suicidal ideation, intent, or plan and denied homicidal ideation. The Board notes that the findings of this VA examination established the Veteran’s 70 percent rating for PTSD, effective September 30, 2015. As such, the Board will adjudicate whether he is entitled to a rating in excess of 70 percent, from September 30, 2015, forward. In a June 2016 letter, the Veteran’s treating psychiatrist at VA, noted that he continued to suffer from marked hypervigilance, hyperarousal, nightmares, flashbacks, emotional withdrawal, irritability, isolation, and memory disturbances. He had marked work difficulties, frequent write-ups, and confrontations. The psychiatrist concluded that he was totally and permanently disabled. The Veteran’s post-service treatment records during this period on appeal do not reveal any findings consistent with total social and occupational impairment. The treatment records do show that his treating physician, when treating him for asthma, stated that his PTSD and anger was an ongoing issue and challenged their attempt to better understand his asthma condition. See VA Treatment Record dated January 16, 2018. He also reported the following ongoing issues; nightmares, increased startle response, hyperarousal, hypervigilance, and isolation. See VA Treatment Record dated August 3, 2017. He also reported that he was having more stress at work. Id. The Veteran provided testimony before the undersigned VLJ at an August 2018 Board hearing. He testified that he received quarterly treatment for PTSD at VA with his treating psychiatrist. He reported that he was still working as a mail carrier and did so because it was in his best interest, in terms of his physical and mental well-being because it kept him active. He also reported that his grandchildren were his whole world, but also stated that he could not be around anyone for more than an hour. The Veteran was afforded a VA examination in July 2020. After a review of the Veteran’s claims file and an in-person examination, the examiner found that the best summary of the Veteran’s level of impairment was total occupational and social impairment, a finding consistent with a 100 percent rating. The Veteran reported that he lived alone and received a lot of support from the mother of his children. He reported having four adult children, with good current relationships with them. He stated that if it was not for his children and grandchildren, he would not be here. He reported frequently getting frustrated with people and isolating behavior. He reported that he was still working as a mail carrier, but had a low level of job satisfaction. He stated that walking long distances for the job was helpful, but reported a deteriorating ability to maintain appropriate behavior and worsening problems with irritability and impulse control. He reported that he was not currently receiving mental health treatment and the last time he did was six months earlier. He stated that he was not sleeping well, had worsening anxiety and depression, and could not get close to people. The examiner reported the following symptoms; depressed mood, anxiety, suspiciousness, near-continuous panic, chronic sleep impairment, mild memory loss, circumstantial speech, speech intermittently illogical, impaired judgment, disturbances of motivation and mood, inability to establish and maintain effective relationships, and impaired impulse control. To obtain a total schedular rating for his PTSD during this time period, the evidence must show that the Veteran’s PTSD causes total social impairment and total occupational impairment. 38 C.F.R. § 4.130, Diagnostic Code 9411. Here, the evidence does not show total social impairment. The Veteran has consistently reported in his treatment records and at the VA examinations of record that he maintains a relationship with the mother of his children and that he enjoyed spending time with his grandchildren. He also reported at the July 2020 VA examination that he had good current relationships with his adult children and stated that if it was not for his children and grandchildren, he would not be here. Thus, although the evidence of record shows signs of social impairment, it does not suggest total social impairment. Neither does the evidence show total occupational impairment. At the September 2015 and the July 2020 VA examinations, he reported that working as a mail carrier and having to walk long distances helped his physical, mental, and emotional well-being. He also testified at the August 2018 Board hearing that he continues to work because he believes that it is helping his overall health. His treatment records show that he has acknowledged that his job is stressful. He also reported that he had trouble interacting with co-workers, supervisors, and customers, telling them to get away from him. However, the evidence nonetheless shows that the Veteran has maintained his current position as a mail carrier since 1984. Although he has shown occupational difficulties, the evidence of record does not show total occupational impairment prior to the assignment of 100 percent rating for PTSD. There is no question that the Veteran is impacted by his PTSD, evidenced by his continuous depressed mood, anxiety, panic attacks, hypervigilance, isolating behavior, chronic sleep impairment, mild memory loss, impaired judgment, circumlocutory speech, disturbances of motivation and mood, and nightmares. However, the impact of these symptoms is generally more congruent with the currently assigned disability rating of 70 percent during this period on appeal, than they would be with a higher rating. For a total rating it must be shown that the Veteran has both total social and total occupational impairment as a result of his PTSD, and such simply is not shown by the record. Here, the Veteran has consistently displayed some level of social functioning, as evidenced by his relationships with the mother of his children, his grandchildren, and his adult children. Having always displayed some level of social competence, the Veteran does not now, nor at any time during the appeal period, have total, meaning complete, social impairment. He has also shown some level of occupational functioning, as he still currently employed as a mail carrier. The evidence of record also does not show any of the other symptoms identified in the schedular criteria for a 100 percent rating for PTSD such 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 minimum personal hygiene); disorientation to time or place; or memory loss for names of close relatives, own occupation, or own name. To the contrary, he was specifically found by the September 2015 VA examiner to have the ability to maintain minimal personal hygiene and other basic activities of daily living and was oriented to time or place; did not have memory loss for names of close relatives, occupation, or own name; did not have delusions of hallucinations; did not have inappropriate behavior; and was not a danger of hurting self or others. Further, the July 2020 VA examiner did not note any of the symptoms associated with a 100 percent rating. Here, the Board has not uncovered any evidence of psychiatric symptoms which would fall into the rating criteria for a 100 percent rating under the General Rating Formula for Mental Disorders. The Board notes that a September 2020 rating decision increased the Veteran’s rating for PTSD to 100 percent, effective July 30, 2020, the date of a VA examination. The RO assigned the 100 percent rating based on circumlocutory speech, inability to establish and maintain effective relationships, suspiciousness, depressed mood, disturbances of motivation and mood, impaired judgment, circumstantial speech, anxiety, impaired impulse control, and chronic sleep impairment. The Board has found that the evidence of record is against finding that the Veteran has total social and occupational impairment; however, the Board will not disturb the favorable findings by the RO in the September 2020 rating decision, assigning a 100 percent rating for PTSD. The Board also acknowledges the Veteran’s treating psychiatrist wrote the Veteran a 2016 letter stating that he was totally and permanently disabled. The treating psychiatrist reported that he continued to suffer from marked hypervigilance, hyperarousal, nightmares, flashbacks, emotional withdrawal, irritability, isolation, and memory disturbances; and had work difficulties. Although the treating psychiatrist came to the ultimate conclusion that the Veteran was totally and permanently disabled, the psychiatrist did not support their conclusion with any evidence supporting a 100 percent rating under the criteria of Diagnostic Code 9411. For example, the listed symptoms did not meet the any criteria for a 100 percent rating under Diagnostic Code 9411. Further, the psychiatrist did not give any examples or reasons explaining why or how he was totally socially and occupationally impaired. Accordingly, a rating in excess of 70 percent for PTSD, from September 30, 2015 to July 30, 2020, is denied. 3. An initial compensable rating for bilateral hearing loss is denied. The Veteran asserts that he is entitled to an initial compensable rating for bilateral hearing loss. Specifically, he asserts that he has difficulty with hearing conversations. He also believes that the degree of hearing loss is greater than the hearing tests show. See Form 9 dated May 7, 2018. VA received the Veteran’s service connection claim for bilateral hearing loss on February 28, 2017. A May 2017 rating decision granted the Veteran’s claim for service connection for bilateral hearing loss and assigned a noncompensable rating, effective February 28, 2017, the date of claim. The Veteran disagreed with that decision and a June 2020 Board decision remanded the claim for a new VA examination, due to assertions of worsening symptoms. The Veteran was afforded a VA examination in July 2020, to determine the current nature and severity of his hearing loss. The Board finds that the July 2020 VA audiological examination is in compliance with the June 2020 Board remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Disability ratings for hearing loss are derived from a mechanical application of the rating schedule to the numeric designations resulting from audiometric testing. Lendenman v. Principi, 3 Vet. App. 345 (1992). The rating schedule establishes auditory hearing acuity levels based on average pure tone thresholds and speech discrimination. 38 C.F.R. § 4.85. Ratings for hearing loss are determined in accordance with the findings obtained on audiometric examinations. Ratings for hearing impairment range from 0 percent to 100 percent based on organic impairment of hearing acuity, as measured by the results of the controlled speech discrimination tests, together with the average hearing threshold level as measured by pure tone audiometry tests in the frequencies 1000, 2000, 3000, and 4000 Hertz. To rate the degree of disability from hearing impairment, the rating schedule establishes eleven auditory acuity levels designated from Level I for essentially normal acuity through Level XI for profound deafness. 38 C.F.R. § 4.85, Diagnostic Code 6100. Hearing tests will be conducted without hearing aids, and the results of testing are charted on Table VI and Table VII. 38 C.F.R. § 4.85, Tables VI, VII. Exceptional patterns of hearing impairment are rated under 38 C.F.R. § 4.86. When the pure tone threshold at each of the four specified frequencies of 1000, 2000, 3000, and 4000 Hertz is 55 decibels or more, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VIa, whichever results in the higher numeral. Each ear will be evaluated separately. When the pure tone threshold is 30 decibels or less at 1000 Hertz and 70 decibels or more at 2000 Hertz, the rating specialist will determine the Roman numeral for hearing impairment from Table VI or Table VIa, whichever is higher. That numeral will then be elevated to the next higher Roman numeral. Each ear will be evaluated separately. 38 C.F.R. § 4.86. At no time during the appeal period were each of the four hearing thresholds 55 decibels or greater, or that his pure tone threshold was 30 decibels or less at 1000 Hertz and 70 decibels or more at 2000 Hertz; so no provision of 38 C.F.R. § 4.86, used to evaluate exceptional patterns of hearing impairment, is applicable. 38 C.F.R. § 4.86 (a). An adequate evaluation of impairment of hearing acuity rests upon the results of controlled speech discrimination tests, together with tests of the average hearing threshold levels at certain specified frequencies. 38 C.F.R. § 4.85, Diagnostic Code 6100. The Veteran’s post-service medical records show a February 2017 audiological examination. See VA Treatment Record dated February 27, 2017. The treatment records did not otherwise contain the results of any other audiological testing. The February 2017 VA audiological examination showed pure tone thresholds, in decibels, as follows: HERTZ 500 1000 2000 3000 4000 Avg. Right 20 25 35 50 55 41.25 Left 15 25 50 70 60 51.25 The Veteran’s Maryland CNC test showed that he scored 96 percent in both ears. The Veteran was afforded a VA audiological examination in April 2017. The audiological examination report showed pure tone thresholds, in decibels, as follows: HERTZ 500 1000 2000 3000 4000 Avg. Right 15 25 30 50 60 41.25 Left 15 25 45 60 60 47.50 The Veteran’s Maryland CNC test showed that he scored 96 percent in his right ear and 100 percent in the left ear. The Veteran reported that the functional impact of his hearing loss was having difficulty hearing his partner at home. The Veteran was afforded a VA audiological examination in July 2020. The audiological examination report showed pure tone thresholds, in decibels, as follows: HERTZ 500 1000 2000 3000 4000 Avg. Right 20 35 60 80 80 63.75 Left 25 30 65 80 70 61.25 The Veteran’s Maryland CNC test showed that he scored 88 percent in his right ear and 94 percent in the left ear. The Veteran reported that the functional impact of his hearing loss was having trouble hearing most conversations. The results of the February 2017 VA audiological examination showed an average hearing loss of 41.25 decibels in the right ear and a loss of 51.25 in the left ear. He had a speech discrimination score of 96 percent in both ears. Under Table VI, the February 2017 audiological results show that the Veteran has a Level I impairment in the right ear, combined with a Level 1 impairment in the left ear. A Level I impairment in both ears warrants a noncompensable rating under Table VII. The results of the April 2017 VA audiological examination showed an average hearing loss of 41.25 in the right ear and a loss of 47.50 in the left ear. He had a speech discrimination score of 96 percent in the right ear and 100 percent in the left ear. Under Table VI, the April 2017 audiological results show that the Veteran has a Level I impairment in the right ear, combined with a Level 1 impairment in the left ear. A Level I impairment in both ears warrants a noncompensable rating under Table VII. The results of the July 2020 VA audiological examination showed an average hearing loss of 63.75 in the right ear and 61.25 in the left ear. He had a speech discrimination score of 88 percent in the right ear and 94 percent in the left ear. Under Table VI, the July 2020 audiological results show that the Veteran has a Level III impairment in the right ear, combined with a Level II impairment in the left ear. A Level III impairment in the right ear, with a Level II in the left ear warrants a noncompensable rating under Table VII. Here, the Veteran asserted in his May 2018 substantive appeal, that his hearing had worsened and was entitled to a higher initial rating. Given the Veteran’s complaints of decreased hearing acuity, a new VA examination was scheduled to evaluate the current severity of the hearing loss. The results of the latest VA examination did show a decrease in hearing acuity from 2017 to 2020. However, the mechanical application of the rating schedule to the numeric designations assigned based on the audiometric test results does not reveal findings consistent with a compensable rating. The Board does believe that the Veteran’s hearing problem causes him hardship and is sympathetic to his assertion that his hearing deserves a compensable rating. The Board finds his assertions that he has difficulty listening to conversations to be credible and his audiological test results do show that he indeed has impaired hearing. However, the Board is precluded from deviating from the rating criteria of Diagnostic Code 6100. The Veteran’s audiological test results of record are applied to Table VI and Table VII. 38 C.F.R. § 4.85. Although the Veteran does show diminished hearing acuity, the application of his audiological test results reveals a noncompensable rating. In order to receive a compensable rating, the Veteran would at a minimum need to show a Level II impairment in the better ear and a Level V impairment in the poorer ear. Here, the Veteran’s hearing results have not shown such results; at worst, he showed a Level III impairment in the right ear and a Level II impairment in the left ear. Unfortunately, the audiometric results of record show that the Veteran’s hearing loss is noncompensable under the schedular criteria. The evidence is not in relative equipoise to warrant a higher evaluation. 38 U.S.C. § 5107 (b). Accordingly, an initial compensable rating for the Veteran’s bilateral hearing loss is denied. MATTHEW W. BLACKWELDER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board E. Fu, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.