Citation Nr: 21065517 Decision Date: 10/26/21 Archive Date: 10/26/21 DOCKET NO. 17-32 844 DATE: October 26, 2021 ORDER An increased rating for posttraumatic stress disorder (PTSD), evaluated as 70 percent disabling prior to August 1, 2016, as 50 percent disabling from August 1, 2016 to November 28, 2017, and as 70 percent disabling as of November 29, 2017, is denied. FINDINGS OF FACT 1. The Regional Office (RO's) May 2016 rating decision, which reduced the Veteran's rating for his service-connected PTSD from 70 percent to 50 percent, effective August 1, 2016, considered the required regulatory provisions and afforded the Veteran all required due process. 2. For the period from August 1, 2016 to November 28, 2017, the Veteran's service-connected PTSD is shown to have been productive of symptoms that include anger, irritability, nightmares, and sleep disturbance, but his psychiatric symptomatology did not cause occupational and social impairment with deficiencies in most areas. 3. For the period from January 27, 2014 to July 31, 2016, and as of November 29, 2017, the Veteran's service-connected PTSD is shown to have been productive of symptoms that include anger, irritability, memory impairment, and sleep disturbance, but his psychiatric symptomatology is not shown to have caused total occupational and total social impairment. CONCLUSIONS OF LAW 1. The RO's May 2016 rating decision, which reduced the Veteran's rating for his service-connected PTSD from 70 percent to 50 percent, effective August 1, 2016, was proper; restoration of the 70 percent rating is not warranted. 38 C.F.R. § 3.655. 2. For the period from August 1, 2016 to November 28, 2017, the criteria for a rating in excess of 50 percent for service-connected PTSD have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.7, 4.130, Diagnostic Code 9411. 3. For the period from January 27, 2014 to July 31, 2016, and as of November 29, 2017, the criteria for a rating in excess of 70 percent for service-connected PTSD have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.2, 4.7, 4.130, Diagnostic Code 9411. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS In March 2019, the Board remanded this claim for additional development. Additional medical evidence has been received following the July 2020 supplemental statement of the case that is not accompanied by a waiver of RO review. However, the Board has determined that this evidence is not "pertinent" as defined at 38 C.F.R. § 20.1304 (c) as it does not contain findings material to the issue on appeal. Accordingly, a remand for RO consideration is not required. 1. Increased Rating for PTSD. With regard to the history of the disability in issue, the Veteran is shown to have served in Iraq for over 11 months during his first period of active duty. His awards include the Iraq Campaign Medal. Service treatment reports note treatment for depression in 2005, and a diagnosis of PTSD in 2008. The Veteran was diagnosed with PTSD in an April 2013 VA examination report. See 38 C.F.R. § 4.1. In September 2013, the RO granted service connection for PTSD, evaluated as 70 percent disabling. There was no appeal, and the RO's decision became final. See 38 U.S.C. § 7105(c); 38 C.F.R. § 20.1103. In January 2015, the Veteran filed a claim for an increased rating. In February 2016, the RO proposed to reduce the Veteran's rating from 70 percent to 50 percent. In May 2016, the RO effectuated the reduction, and assigned a 50 percent rating for PTSD effective August 1, 2016. In June 2016, the Veteran filed a notice of disagreement; he subsequently perfected that appeal. In July 2020, the RO granted the claim, to the extent that it increased the Veteran's rating for PTSD to 70 percent, effective November 29, 2017. Given the foregoing, the issue may initially be characterized as entitlement to an increased rating for PTSD, evaluated as 70 percent disabling prior to August 1, 2016, as 50 percent disabling from August 1, 2016 to November 28, 2017, and as 70 percent disabling as of November 29, 2017, to include whether the RO properly reduced the Veteran's rating for PTSD from 70 percent to 50 percent disabling, effective August 1, 2016. Disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. Part IV. If two evaluations are potentially applicable, the higher evaluation 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. When reasonable doubt arises as to the degree of disability, such doubt will be resolved in the Veteran's favor. 38 C.F.R. § 4.3. The Veteran's PTSD is evaluated under 38 C.F.R. § 4.130, Diagnostic Code (DC) 9411, under the general rating formula for mental disorders, which became effective prior to the Veteran's claim for service connection. Under 38 C.F.R. § 4.130, DC 9411, a 50 percent rating is warranted where an acquired psychiatric disability 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- 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. Id. A 70 percent rating 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 ideations; obsessional rituals that 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); 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; 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. Id. The symptoms listed at 38 C.F.R. § 4.130 are not an exclusive or exhaustive list of symptomatology which may be considered for a higher rating claim. Mauerhan v. Principi, 16 Vet. App. 436 (2002). As this appeal was certified to the Board in October 2017, subsequent to the effective date for this change, DSM-5 is applicable to this claim. See 70 Fed. Reg. 45,093-94 (Aug. 4, 2014). In such cases, it is improper to discuss global assessment of functioning scores. Golden v. Shulkin, 29 Vet. App. 221 (2018). When determining the appropriate disability evaluation to assign, the Board's primary consideration is the Veteran's symptoms, but it must also make findings as to how those symptoms impact the Veteran's occupational and social impairment. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 118 (Fed. Cir. 2013); Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). Because the use of the term "such as" in the rating criteria demonstrates that the symptoms after that phrase are not intended to constitute an exhaustive list, the Board need not find the presence of all, most, or even some, of the enumerated symptoms to award a specific rating. Mauerhan, 16 Vet. App. at 442. Nevertheless, as all ratings in the general rating formula are also associated with objectively observable symptomatology and the plain language of the regulation makes it clear that the Veteran's impairment must be "due to" those symptoms, a veteran may only qualify for a given disability by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration. Vazquez-Claudio, 713 F.3d at 118. Propriety of the RO's reduction of the Veteran's rating for PTSD from 70 percent to 50 percent, effective August 1, 2016. Under 38 C.F.R. § 3.105 (e), a reduction in an evaluation of a service-connected disability only requires special adjudication if "the lower evaluation would result in a reduction or discontinuance of compensation payments currently being made." Thus, the special reduction requirements only apply when the appellant will receive less money as the result of the evaluation reduction. See O'Connell v. Nicholson, 21 Vet. App. 89, 93-94 (2007); VAOPGCPREC 71-91, 57 Fed. Reg. 2,316 (1992). The provisions of paragraphs § 3.344 (a) and (b) apply to ratings which have continued for long periods at the same level (5 years or more). They do not apply to disabilities which have not become stabilized and are likely to improve. Reexaminations disclosing improvement, physical or mental, in these disabilities will warrant reduction in rating. See 38 C.F.R. § 3.344 (c). The United States Court of Appeals for Veterans Claims (Court) stated in Lehman v. Derwinski, 1 Vet. App. 339 (1991) that use of parentheses suggests that the five-year time frame is merely a guideline, not a mandate; and that the regulation is devoid of any language which could be construed as intended to establish an inflexible mandatory minimum time period. Although the regulatory requirements under 38 C.F.R. § 3.344 (a) and (b) apply only to reductions of ratings that have continued for long periods at the same level, the Court has held that several general regulations are applicable to all rating reduction cases, regardless of whether the rating at issue has been in effect for five or more years. The Court has stated that certain regulations "impose a clear requirement that VA rating reductions, as with all VA rating decisions, be based upon review of the entire history of the veteran's disability." Brown v. Brown, 5 Vet. App. 413, 420 (1993). The Brown case articulated three questions that must be addressed in determining whether a rating reduction was warranted by the evidence. First, a rating reduction case requires ascertaining "whether the evidence reflects an actual change in the disability." Second, it must be determined whether the examination reports reflecting such change were based upon thorough examinations. Third, it must be determined whether the improvement actually reflects an improvement in the veteran's ability to function under the ordinary conditions of life and work. Brown, 5 Vet. App. at 421. It appears that the procedural safeguards have been met. Specifically, when a reduction in evaluation is considered warranted, a rating proposing a reduction will be prepared setting forth all material facts and reasons. 38 C.F.R. § 3.105(e). In this case, the Veteran was afforded PTSD examinations in May and December of 2015. In February 2016, the RO issued a proposed reduction of the rating for the Veteran's PTSD that would have reduced his combined evaluation from 80 percent to 70 percent. Id. The Veteran was afforded 60 days to respond. In May 2016, the RO effectuated the proposed reduction, and reduced the Veteran's rating for PTSD from 70 percent to 50 percent, with an effective date of August 1. 2016. The Board finds that the RO had an adequate basis for its conclusion that the evidence showed consistent and sustained improvement of the Veteran's PTSD, and that it properly reduced the Veteran's rating for PTSD from 70 percent to 50 percent. In its May 2016 decision, the RO noted the findings in the two 2015 VA PTSD examinations (the findings in those examination reports are discussed in greater detail, infra). The VA examinations took place seven months apart. Both examination reports show that the examiners concluded that the Veteran's symptoms were productive of 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. This most closely corresponds to no more than a 50 percent evaluation under the General Rating Formula. See 38 C.F.R. § 4.130, General Rating Formula. The December 2015 examination report further shows that the Veteran denied any history of inpatient psychiatric hospitalizations or suicide attempts, and that he stated that he had not had mental health treatment since 2013. The examiner stated that he had reviewed the May 2015 VA PTSD examination report, and that there had not been a significant interval change in the Veteran's level of occupational and social functioning following the May 2015 examination. Although current testing placed the Veteran in the moderate range of depression and was suggestive of PTSD, this was "not consistent with his treatment records or his current presentation, which suggested more minimal to mild symptoms." The examiner further concluded that the Veteran was capable of maintaining gainful, full-time employment at either a sedentary or physical job. This evidence is sufficient to show that there was an actual change in the Veteran's PTSD, that an improvement in his disability had actually occurred, and that such improvement actually reflected an improvement in his ability to function under the ordinary conditions of life and work. Brown, 5 Vet. App. at 421. The May and December 2015 VA examination reports reflect this change. The examinations were thorough, as they included the Veteran's subjective history and current findings, and the examiners' estimations of his level of disability. Id. Based on this evidence, the RO concluded, "[a] review of both review exams for posttraumatic stress disorder shows consistent improvement. Therefore, this action has been taken due to the evidence showing sustained improvement." Given the foregoing, the Board finds that the RO's May 2016 reduction of the Veteran's disability rating for his PTSD from 70 percent to 50 percent effective August 1, 2016 was proper. Increased Rating, PTSD. As an initial matter, the Board finds that the Veteran is not a credible historian. There is significant evidence of deception and a lack of credibility. VA progress notes dated between October and November of 2011 include notations of "significant incongruities in his self-report" and that "[e]fforts to coax a trauma narrative were unsuccessful, and generally responded to with evasive gestures." A December 2015 VA PTSD DBQ notes that the Veteran was vague and elusive about his traumatic stressors. The examiner stated that although the Veteran reported taking small arms fire while in a guard tower, and fear encountering passengers in vehicle during an alert to watch for a VBIED (vehicle-born improvised explosive device), this was not reported in prior interviews. Although the Veteran described his first deployment as "a cake walk," he reported to an Army psychologist in 2008 that his significant trauma memory was the images of wounded children that reminded him of his son. The examiner stated that the Veteran "did not disclose this during this interview." There is also evidence of a desire for financial gain and personal advantage. See VA PTSD consultation (noting that the Veteran "wants out of the National Guard and stated that he was told [that the examiner] could write a letter"); October 2013 VA progress note (noting "patient states he is trying to get 100 percent disability"). Notwithstanding the Veteran's denials, there is also evidence of behavior reflecting poor character. VA progress notes dated in 2011 note a history of arrests for domestic violence based on sexual assault, with two PFAs (protections from abuse). However, the Veteran denied a legal or behavioral history during his September 2017 VA examination. A December 2019 VA PTSD DBQ shows that the Veteran reported that there was a warrant out for his arrest involving a charge of leaving the scene of an October 2019 accident. A December 2015 VA PTSD disability benefits questionnaire (DBQ) shows that the Veteran inaccurately gave the examiner the impression that he had two combat tours overseas. Specifically, he stated that he was deployed twice, and that his second deployment was as a part of OIF (Operation Iraq Freedom) in 2008 with a "bunch of Cav[alry] Scouts." The Veteran further stated, "[H]e had more engagement with the enemy during his first deployment." See also October 2011 VA PTSD consultation report (initial psychological evaluation) (indicating that the Veteran reported that he "was deployed twice to Iraq"). The Veteran's discharge from his first period of active duty indicates service in Iraq, with and over 11 months of foreign service. However, his discharge from his second period of active duty shows that it lasted just over one month, from September 19, 2008 to October 24, 2008, with no indication that he was deployed overseas during this period of active duty. See also Veteran's personnel file (DA Form 2-1); October 2008 memorandum for unit commander at Camp Shelby (showing that the Veteran was found to be not deployable); November 2008 VA progress note ( "The patient had been deployed in the past, March 2005-2006, to Iraq. He was going to be deployed again ... and they stopped his deployment there because of his possible PTSD"). Accordingly, the Veteran is found not to be a credible historian. Caluza v. Brown, 7 Vet. App. 498, 511 (1995). For all time periods on appeal, the Board notes that a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is in effect from May 2013 to March 2021. Rating in excess of 50 percent, August 1, 2016 to November 28, 2017. The relevant evidence for these two time periods is summarized as follows: A July 2017 residual functional capacity evaluation ("RFCE") from S.W., M.D. indicates that the Veteran would not be able to maintain substantially gainful employment due to both physical and mental impairments. The evaluation contains findings relevant to musculoskeletal and mental functions. It notes that the Veteran's "concentration would be basically normal" but that he would not be able to stay focused for at least seven hours of an eight-hour workday more than three days a month. A statement from the Veteran's spouse, dated in August 2017, shows that she reports that she had known the Veteran for about seven years. His memory had been going downhill for about two years. She had to remind him to take his medications and of doctor's appointments. He also had depression and anger. He once grabbed her father by the throat. He avoided crowds, isolated himself, he repeated himself a lot, and he was very forgetful. A VA PTSD DBQ dated in September 2017, signed by J.F., Ph.D. in October 2017, shows that the Veteran complained that he did become easily agitated and angry and that he did "yell and get loud," but that he did not destroy property or become physically violent towards other people. He reported that he had been married for five years and that he had five children. He said that he spent most of the time in his basement playing video games, but that he also took care of his children and mother-in-law, with whom he lived. He had not worked since January 2013, when he stopped due to back pain and back problems. He had tried to go back to college, but dropped out due to problems with other students. The Veteran was noted to be receiving mental health treatment at VA until 2011. He stated that he belonged to the Masons and an associated motorcycle group. He socialized with people from this group on a monthly basis. He denied any relevant legal, behavioral, or substance abuse history. The DBQ indicates that the Veteran's symptoms included depressed mood, anxiety, suspiciousness, panic attacks that occurred weekly or less often, chronic sleep impairment, mild memory loss, impaired judgment, 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 work like setting. He was neatly groomed and appropriately dressed. He was alert and oriented times four. His speech had a normal rate, rhythm, and volume. His thinking was goal directed and logical. His mood was euthymic, and he exhibited a full range of affect. There was no evidence of psychosis or delusional ideation. He denied suicidal or homicidal ideation. The diagnosis was PTSD. The examiner indicated that the Veteran's symptoms were productive of occupational and social impairment with reduced reliability and productivity. The Board finds that a rating in excess of 50 percent is not warranted. The Veteran has been married since about 2012. He had not worked since January 2013, when he stopped due to back pain and back problems. The Veteran is not shown to have received mental health treatment during the time period in issue. He stated that he belonged to a social organization, i.e., he was a Mason and belonged to an associated motorcycle club. He socialized with people from this group on a monthly basis. There was no evidence of suicidal ideations, obsessional rituals, speech intermittently illogical, obscure, or irrelevant, near continuous panic or depression affecting the ability to function independently, appropriately and effectively, impaired impulse control, spatial disorientation, neglect of personal appearance and hygiene. The September 2017 VA examiner concluded that the Veteran's symptoms were productive of occupational and social impairment with reduced reliability and productivity. This most closely corresponds to no more than a 50 percent evaluation under the General Rating Formula. 38 C.F.R. § 4.130. The July 2017 RFCE indicates that the Veteran would not be able to maintain substantially gainful employment; however, this was due to both physical and mental impairments. This report does not contain findings implicating the criteria for a rating in excess of 50 percent. In summary, the evidence is insufficient to show that the Veteran had such symptoms as suicidal ideation with plan or intent, obsessional rituals, defects in speech, near-continuous panic or depression which affected his ability to function independently, appropriately, and effectively; impaired impulse control, spatial disorientation, neglect of personal appearance and hygiene, or difficulty in adapting to stressful circumstances, nor are there other psychiatric symptoms shown to have resulted in such impairment, such that a 70 percent rating is warranted. See 38 C.F.R. § 4.130; Vazquez-Claudio. Accordingly, a rating in excess of 50 percent for the period from August 1, 2016 to November 28, 2017 is not warranted. Rating in excess of 70 percent for PTSD, January 27, 2014 to July 31, 2016, and as of November 29, 2017. The relevant evidence is summarized as follows: A VA Form 21-8940, received in October 2013, shows that the Veteran reported that he last worked as a driver between March 2012 and January 2013, with prior employment between October 2009 and April 2012 for a security company. He further stated that he was "still enrolled in school," although he found it difficult. Private treatment reports from S.W., M.D. of Lancaster General Health, dated between 2014 and 2015, primarily show treatment for non-psychiatric symptoms. However, this evidence shows that the Veteran was noted to have PTSD, with a notation that "but that seems relatively mild now." There were notations that his PTSD was stable, and that he used alcohol occasionally. The Veteran was noted to be married and "on permanent disability." He was alert and oriented times three. A VA PTSD DBQ dated in May 2015 shows that the Veteran was noted to have symptoms that include anxiety and panic attacks that occur weekly or less often. There was no history of behavioral or legal problems, suicidal or homicidal ideation, or alcohol or drug abuse. There was no past or current history of either active or passive suicidal thoughts or attempts. The Veteran currently denied any intent, plans, wishes, or goals to harm self or others. He was slow to warm up to people and tended to be guarded, but when he got to know them he reported that he did much better and felt more comfortable. He described fairly normal relations. He had been unemployed since he was a tow truck driver in May 2013, although he had been going to school. He reported a history of changing jobs and schools due to losing interest, but said that he had never been fired. He was busy at home with five children. He liked to ride a motorcycle with his wife. On examination, his behaviors were within normal limits. He gave good eye contact and speech was unremarkable. He denied any active or passive suicidal or homicidal thoughts; and said that he had no intent, plans, wishes, or goals to harm himself. His thought process was clear, coherent, goal-directed, and logical. His thought content was within normal limits. Judgment and insight were good. The diagnosis was PTSD. The examiner indicated that the Veteran's symptoms were productive of 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. A VA PTSD DBQ, dated in December 2015, shows that the Veteran reported that much of the time he felt "fine," frequent nightmares, and that he had irritability lasting an hour or two. He stated that his wife told him he was irritable or "hard on the kids" on a daily basis. He reported a history of having been married three times. He had been married to his third wife for three years, and they have been together for seven years. They go out to eat once every two to three weeks. He was a Mason, he attended monthly meetings, and he belonged to a Mason motorcycle club. He saw his mother and stepfather almost every day. He had three close friends, and they talked on the phone almost daily. He spent his time taking care of the home and children. The Veteran denied any history of inpatient psychiatric hospitalizations or suicide attempts. The examiner noted that he had not had mental health treatment since 2013. The examiner stated that testing placed him in the moderate range of depression, and was suggestive of PTSD. However, this was not consistent with his treatment records, or his current presentation, which suggested more minimal to mild symptoms. His symptoms were noted to include anxiety, suspiciousness, chronic sleep impairment, 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. The examiner stated that there had not been a significant interval change since the May 2015 examination. The diagnosis was PTSD. The examiner indicated that the Veteran's symptoms were productive of 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. A PTSD DBQ from Dr. H.G., dated November 29, 2017, shows that the Veteran complained of anxiety, depression, and "overt hallucinations." He reported that he was married to his third wife for five years, and that he had five school-aged children. He live at home with his mother-in-law, three stepchildren, and oldest child. He was socially isolated and withdrawn. He denied any legal or behavioral history. He had been sober for four or five years. He last worked for one year as a tow truck driver, in 2013. His symptoms were noted to include panic attacks more than once a week; near-continuous panic or depression affecting the ability to perform independently, appropriately and effectively; persistent delusions or hallucinations; mild memory loss; impairment of long and short-term memory; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships; difficulty in adapting to stressful circumstances; including work or a work like setting; and an intermittent ability to perform activities of daily living, including maintenance of minimal personal hygiene. On examination, speech was normal. Attention was normal. Concentration was variable. Thought content was appropriate. Organization of thought was goal-directed. Judgement was average. Mood was anxious and nervous. The diagnosis was PTSD. Dr. H.G. indicated that the Veteran's symptoms were productive of occupational and social impairment with deficiencies in most areas; such as work, school, family relations, judgment, thinking, and/or mood. An associated RFCE from Dr. H.G., dated November 29, 2017, notes that the Veteran would not be able to stay focused for at least seven hours of an eight-hour workday, that he would miss three or more days a month due, and need to leave the workplace early three or more times a month, because of mental problems. If he were subject to the normal pressures and constructive criticisms of a job, he would respond inappropriately more than once a month, in an angry manner, but he would not actually become violent. Reports from H.S., M.D., dated in December 2017, include a RFCE with findings similar to Dr. H.G.'s November 2017 RFCE. Dr. H.S. concluded that the Veteran was unable to maintain substantially gainful employment due to both physical and mental impairments. A report from S.B., Ph.D., dated November 29, 2017, cites to Dr. S.W.'s July 2017 report and concludes that the Veteran was unable to maintain substantially gainful employment due to both physical and mental impairments. A VA PTSD DBQ, dated in December 2019, from F.S., Ph.D., shows that the Veteran was noted to be living with his third spouse, his mother-in-law, and three children. His marriage was characterized as committed and supportive, although they had occasional conflicts and arguments. The Veteran reported that his wife complained that he played video games too much. He reported sleeping about 12 hours a day, from 1 a.m. to 10 a.m., and then falling asleep about 15 to 20 minutes later until 1 p.m. or 2 p.m." He watched television and occasionally went out to eat with his family. He contacted his mother about once a week, his father about every two weeks, and they visit him at times. He had friends with whom he stayed in touch, mostly during the summer months, when they rode motorcycles together. Outside of the summer months he claimed to stay mostly to himself. He reported that his last job was as a tow truck driver in 2013. He claimed increased nightmares and avoidance of others in the past two years. He complained of having a short temper that was never physically expressed. He had been sober for the past six to seven years. The DBQ indicates that the Veteran's symptoms were primarily consistent with those noted in the September 2017 VA DBQ, but also included an inability to establish and maintain effective relationships, and an intermittent ability to perform activities of daily living, including maintenance of minimal personal hygiene. On examination, speech was fluent. Dress was casual and neat. Thought processes were coherent and goal directed with no evidence of hallucinations, delusions, or paranoia in the evaluation setting. Affect was full range and appropriate to speech and thought content. He was relaxed and did not appear to be in any visible distress. Mood today was characterized as "blah," "meaning flat." Sensorium was clear. He was fully oriented to all spheres. The diagnosis was PTSD. Dr. F.S. indicated that the Veteran's symptoms were productive of occupational and social impairment with reduced reliability and productivity. Dr. F.S. stated that at this time, the Veteran was not reporting symptoms as extensive or as severe as those reported on the November 2017 PTSD DBQ from Dr. H.G. Specifically, the Veteran at this time denied experiencing significant symptoms of depression, panic attacks occurring more than once per week, and persistent delusions or hallucinations which were reported in Dr. H.G. 's report. At that time, Dr. H.G. opined that his level of occupation and social impairment indicated deficiencies in most areas such as work, school, family relations, judgment, thinking, and/or mood. Given the decreased extent and severity of the Veteran's current symptoms, he would not meet this level of impairment at this time. The Veteran's current symptoms were more consistent at this time with those reported on the October 2017 PTSD DBQ conducted by Dr. J.F., who concluded his occupational and social impairment was consistent with reduced reliability and productivity which Dr. F.S. believed to be more consistent with his findings. Symptoms of this evaluation presented limitations in his ability to perform occupational tasks requiring remembering and carrying out complex instructions, and the ability to make judgments on complex work-related decisions. Furthermore, because of the PTSD identified symptoms he may have limitations with sustained follow-through, reliability, and consistency as well as fluctuations in his ability to persist and maintain pace depending on the work environment. Although he reported difficulty establishing and maintaining effective work relationships, he appeared to interact appropriately with the public and it was expected that he would be able to do the same with co-workers and supervisors provided PTSD related triggers can be avoided. He may have some difficulty however responding to significant or stressful changes in a work setting. In consideration of the evidence reviewed and current findings from this evaluation, Dr. F.S. concluded that the Veteran's occupational and social impairment is to a degree where it is of reduced reliability and productivity. In 2019, the Veteran submitted several articles. These articles include a summary of a presentation on acceptable levels of absenteeism, an article titled, "Psychiatric Status and Work Performance of Veterans of Operations Enduring Freedom and Iraqi Freedom," which states that there is some initial evidence that OEF-OIF veterans who screen positive for both diagnosis-level and subthreshold PTSD symptoms are more likely than those without significant PTSD symptoms to have multiple employment difficulties, including problems finding a job, difficulty with coworkers, and more missed workdays in the past month. As the VA continues to try to meet the evolving needs of OEF-OIF veterans, care models integrating interventions for psychiatric symptoms and work impairments should be considered. Other articles include "Impact of Social Challenges on Gaining Employment for Veterans With Posttraumatic Stress Disorder: An Exploratory Moderator Analysis," noting that when a person is chronically unemployed, he or she tends to inherit family care responsibilities, and that the greatest impact was that of family care burden. "The Civilian Labor Market Experiences of Vietnam-Era Veterans: The Influence of Psychiatric Disorders," notes that psychiatric health may assume added importance in the labor supply decisions of veterans as opposed to the general population because of the availability of VA disability compensation. However, a study has shown that the work disincentive effects of VA disability benefits are modest. Hence, estimated effects of mental illness on labor supply and earnings most likely reflect its debilitating effects on work effort. An article "Posttraumatic stress disorder and quality of life ..." notes that the findings on PTSD and quality of life in OEF/OIF veterans are strikingly comparable with findings obtained from other war cohorts and from nonveterans. PTSD symptom severity and symptom cluster scores were also positively associated to higher unemployment rates. Improved quality of life should be prioritized as a goal of treatment. The Board finds that the criteria for a rating in excess of 70 percent have not been met. The findings in such areas as the Veteran's memory, judgment, insight, thought processes, speech, orientation, and hygiene, and the lack of evidence of such symptoms as delusions or hallucinations, do not warrant the conclusion that the criteria for a rating in excess of 70 percent have been met. The Veteran has reported that he quit working in 2013 due to back pain. The findings in the DBQs have been discussed. The Veteran has been married since about 2012. He is shown to go on outings with his motorcycle club. He is not shown to be receiving ongoing mental health care. The May 2015, December 2015, and December 2019 DBQs show that the examiners concluded that the Veteran's symptoms are productive of occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, and occupational and social impairment manifested by reduced reliability and productivity. These conclusions most closely correspond to no more than a 30 percent rating (May and December 2015 DBQs), or a 50 percent rating (December 2019 DBQ), under the General Rating Formula. See 38 C.F.R. § 4.130, General Rating Formula. To the extent that the Dr. H.G.'s November 2017 DBQ and Dr. S.B's report indicate that their conclusions are based on reports of auditory and/or visual hallucinations, to include "persistent" delusions or hallucinations, and panic attacks occurring more than once per week, this would appear to have been based on the Veteran's reports. However, he has been found not to be a credible historian, and the majority of the evidence shows that the Veteran does not have persistent audio or visual hallucinations, nor does he have panic attacks more than once a week. See e.g., VA progress notes; December 2015 VA DBQ (in which the Veteran denied ever having hallucinations in any sensory modality); September 2017 VA DBQ (indicating panic attacks that occur weekly or less often); December 2019 VA DBQ (noting that the Veteran denied experiencing significant symptoms of depression, panic attacks occurring more than once per week, and persistent delusions or hallucinations). These findings and the conclusions upon which they are based have therefore been afforded reduced probative value. Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997). The Board further notes that Dr. H.G.'s November 2017 DBQ shows that she concluded that the Veteran's symptoms are productive of occupational and social impairment with deficiencies in most areas, and that this most closely corresponds to no more than a 70 percent evaluation under the General Rating Formula. See 38 C.F.R. § 4.130, General Rating Formula. The Board has also considered the opinions on the Veteran's employability, as discussed supra. However, these appear to have been based on both physical and mental impairments, and the Board has determined that Dr. S.B.'s report warrants reduced probative value. The findings in this evidence do not provide a basis to find that the criteria for a rating in excess of 70 have been met for PTSD. There is insufficient evidence of 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, disorientation to time or place, memory loss of names of close relatives, own occupation, or own name; nor are there other psychiatric symptoms of a "similar severity, frequency, and duration" as those required for a 100 percent evaluation under the General Rating Formula. Vazquez-Claudio. Given the foregoing, the Board finds that the Veteran's symptoms are not of such severity to approximate, or more nearly approximate, the criteria for a rating of 100 percent under DC 9411. Id.; see also 38 C.F.R. § 4.7. The Board has considered the Veteran's statements and the lay statement. The Board is required to assess the credibility and probative weight of all relevant evidence. McClain v. Nicholson, 21 Vet. App. 319, 325 (2007). In doing so, the Board may consider factors such as facial plausibility, bias, self-interest, and consistency with other evidence of record. Jandreau v. Nicholson, 492 F.3d 1372, 1376 (Fed. Cir. 2007). Claimants are generally considered to be competent to report their symptoms, as these observations come to them through their senses. Layno v. Brown, 6 Vet. App. 465, 469 (1994). However, the Veteran has been found not to be a credible historian. Disability ratings are made by the application of a schedule of ratings which is based on average impairment of earning capacity as determined by the clinical evidence of record. In this case, the Board has determined that the medical evidence is more probative of the issue, and that it outweighs the lay statements. Therefore, the Board finds that the medical findings, which directly address the criteria under which the disability in issue is evaluated, are more probative than the Veteran's written testimony, and the lay statement, as to the severity of the Veteran's disability. In reaching this decision, the Board considered the doctrine of reasonable doubt; however, as the preponderance of the evidence is against the appellant's claim, the doctrine is not for application. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). L. Chu Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T.S.E., 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.