Citation Nr: 21066114 Decision Date: 10/28/21 Archive Date: 10/28/21 DOCKET NO. 21-00 416 DATE: October 28, 2021 ORDER 1. The motion for reversal or revision of a June 2018 decision in which the Board of Veterans' Appeals (Board) dismissed the Veteran's claim for entitlement to an increased rating for depression with posttraumatic stress disorder (PTSD) is granted. 2. Entitlement to restoration of a 70 percent disability rating for major depressive disorder (major depression) and PTSD is denied. FINDINGS OF FACT 1. With respect to the Board's June 2018 dismissal of the claim for entitlement to an increased rating for depression with PTSD, although the correct facts, as they were known at the time of the June 2018 decision were before the Board, the statutory or regulatory provisions then extant in June 2018 were not correctly applied by the Board, and the failure to apply those laws and regulations manifestly changed the outcome of the Board's decision. 2. A February 2014 reduction of the disability evaluation for major depression and PTSD from 100 percent to 50 percent effective May 1, 2014, which was subsequently increased to 70 percent from that date in a February 2015 rating decision, was made with evidence of sustained improvement in the disability that makes it reasonably certain that the improvement would be maintained under the ordinary conditions of life; and it was made with adherence to applicable adjudication standards. CONCLUSIONS OF LAW 1. The June 2018 decision in which the Board dismissed the Veteran's claim for an entitlement to an increased rating for depression with PTSD, was clearly and unmistakably erroneous. 38 U.S.C. §§ 5109A, 7111; 38 C.F.R. §§ 3.105, 3.344, 20.1403, 20.1404. 2. The criteria for restoration of a 100 percent rating following reduction from the 100 percent disability rating to 50 percent from May 1, 2014, which was later increased to 70 precent from that date, for major depression and PTSD, have not been met. 38 U.S.C. §§ 1155, 5017; 38 C.F.R. §§ 3.102, 3.105(e), 3.344, 4.130, Diagnostic Code (DC) 9411-9434. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 1996 to December 1996 and from July 2005 to June 2006. This matter comes before the Board of the Department of Veterans Affairs (VA) as an original action on the February 2021 motion by the Veteran to revise or reverse, on the basis of clear and unmistakable error, a June 2018 Board decision. 1. The motion for reversal or revision of a June 2018 decision in which the Board of Veterans' Appeals (Board) dismissed the Veteran's claims for an entitlement to an increased rating for depression with PTSD A prior final Board decision must be reversed or revised where evidence establishes that there is CUE in the prior final decision. 38 U.S.C. §§ 5109A, 7111; 38 C.F.R. §§ 20.1400-02. All final Board decisions are subject to revision on the basis of CUE except for those decisions that have been appealed to and decided by the Court and decisions on issues which have subsequently been decided by the Court. 38 C.F.R. § 20.1400. Motions for review of prior Board decisions on the grounds of CUE are adjudicated pursuant to the Board's Rules of Practice. 38 C.F.R. Part 20. Clear and unmistakable error is a very specific and rare kind of error. It is the kind of error, of fact or of law, that when called to the attention of later reviewers compels the conclusion, to which reasonable minds could not differ, that the result would have been manifestly different but for the error. CUE is established when the following conditions are met: (1) either (a) the correct facts in the record were not before the adjudicator, or (b) the statutory or regulatory provisions in existence at the time were incorrectly applied; (2) the alleged error must be "undebatable," not merely "a disagreement as to how the facts were weighed or evaluated;" and (3) the commission of the alleged error must have "manifestly changed the outcome" of the decision being attacked on the basis of CUE at the time that decision was rendered. Evans v. McDonald, 27 Vet. App. 180, 185 (2014), aff'd, 642 F. App'x 982 (Fed. Cir. 2016); Damrel v. Brown, 6 Vet. App. 242, 245 (1994); Russell v. Principi, 3 Vet. App. 310, 313-14 (1992). Review for clear and unmistakable error in a prior Board decision must be based on the record and the law that existed when that decision was made. To warrant revision of a Board decision on the grounds of clear and unmistakable error, there must have been an error in the Board's adjudication of the appeal which, had it not been made, would have manifestly changed the outcome when it was made. If it is not absolutely clear that a different result would have ensued, the error complained of cannot be clear and unmistakable. 38 U.S.C. § 7111; 38 C.F.R. §§ 20.1403, 20.1404. The error must be of a type that is outcome-determinative, and subsequently developed evidence may not be considered in determining whether an error existed in the prior decision. See Porter v. Brown, 5 Vet. App. 233, 235-36 (1993); Glover v. West, 185 F.3d 1328 (Fed. Cir. 1999). A manifest change in the outcome of an adjudication means that, absent the alleged CUE, the benefit sought would have been granted at the outset. King v. Shinseki, 26 Vet. App. 433, 441 (2014). The standard is not whether it is reasonable to conclude that the outcome would have been different. Id. at 442. By way of background, in a November 2006 rating decision, the RO granted service connection for depressive disorder, not otherwise specified, and assigned a 50 percent rating, effective June 3, 2006. In a February 2008 rating decision, the RO recharacterized the psychiatric disorder as major depression and assigned a 100 percent rating, effective December 13, 2007. In an August 2010 rating decision, the RO granted service connection for PTSD and recharacterized the Veteran's service-connected psychiatric disorder, to include PTSD, and continued the 100 percent disability rating. In an October 2013 rating decision, the RO proposed to reduce the rating for major depression and PTSD to 50 percent and a due process letter was sent to the Veteran in November 2013. In January 2014, the Veteran filed a premature notice of disagreement (NOD) with the proposed reduction, as it was not promulgated as noted by the RO in a February 2014 letter. In a February 2014 rating decision, the RO effectuated the reduction of the rating for major depression and PTSD, effective from May 1, 2014. The Veteran filed a notice of disagreement (NOD) in July 2014, which was filed by the DAV. The Veteran's current attorney of record filed an NOD in January 2015 in which he wrote that the Veteran disagreed with the RO's February 2014 rating decision for the specific issue for the rating given to the Veteran's PTSD and major depression. A statement of the case (SOC) was issued in February 2015, and the representative filed a VA Form 9, Appeal to the Board, in March 2015. The appeal was certified and transferred to the Board in 2017. Notably, in a February 2015 rating decision issued prior to the SOC (which was issued approximately three weeks later), the RO granted an increased rating of 70 percent for PTSD effective from May 1, 2014. The RO explained that the RO received the January 2014 premature NOD and also incorrectly noted that there is no indication a statement of disagreement following the February 2014 rating decision that effectuated the reduction rating for major depression and PTSD was received. In March 2015, the Veteran submitted new claims for service connection for anxiety and sleep disturbance, claimed as related to her major depression and PTSD. The RO interpreted the claims as a claim for a higher rating for major depression and PTSD. In March 2015, the Veteran filed an NOD and requested a personal hearing. An August 2015 rating decision explained that a decision on the increased rating for PTSD was deferred. In January 2016, the Veteran filed an NOD with the August 2015 rating decision that deferred a determination on the increased rating for major depression and PTSD. The Veteran wrote that she was seeking the highest rating and earliest effective date, to include TDIU. In September 2016, the Veteran filed a claim for a higher rating for major depression and PTSD. In March 2018, the Veteran's attorney submitted a statement addressed to the VA Evidence Intake Center and noted enclosure of withdrawal of specific claims. The Veteran's attorney wrote "I am writing to inform you that [the Veteran] would like to withdraw the following claims currently on appeal: Anxiety, Increased Rating for Post Traumatic[] Stress Disorder . . . Post Traumatic Disorder, Military Sexual Trauma, Headaches, and Irritable Bowel Syndrome." In a June 2018 decision, the Board explained that the Veteran's attorney requested to withdraw the Veteran's appeal of the issues of entitlement to service connection for IBS, and entitlement to an increased rating for depression with PTSD and thus there remained no allegations of errors of fact or law for appellate consideration of these issues. The Board explained it did not have jurisdiction to review the appeal of these issues and dismissed Veteran's claims for entitlement to service connection for IBS and entitlement to an increased rating for depression with PTSD. In the September 2019 motion, the Veteran, through her attorney, contends that the Board committed CUE in the June 2018 Board decision that dismissed her appeal for reduction of the rating for major depression and PTSD in the February 2014 rating decision. The attorney argues that the Veteran's withdrawal request was not sufficient for a withdrawal because the case involved multiples issues, and her withdrawal did not specify the issues and it was not addressed to the Board, therefore it was not a sufficient withdrawal under 38 C.F.R. § 20.204. The attorney contends that the March 2018 letter was a withdrawal of the January 2015 NOD and that the letter did not withdraw the issue of improper reduction as of that date and that Board's Rules of Practice applied. The attorney contends that the outcome in this case would have been different because the Veteran's appeal would have not been dismissed had the regulation been applied correctly. As a threshold matter, the Board finds that the arguments advanced by the Veteran and her attorney allege CUE with the requisite specificity, and thus meet the filing and pleading requirements of 38 C.F.R. §§ 20.1400 (a), and 1404(a), (b). The Board will now consider the substance of the claim, in the analysis that follows. At the outset, as the Veteran and her attorney limited their motion to the Board's July 2018 dismissal of the issues of an initial rating higher than 70 percent for depression with PTSD and did not provide any argument as to the July 2018 Board dismissal of the claim for service connection for irritable bowel syndrome, therefore, the Board will not address this issue. At the time of the June 2018 Board decision, under § 20.204 Rule 204, titled, "Withdrawal of Appeal," it provided the following: (a) When and by whom filed. Only an appellant, or an appellant's authorized representative, may withdraw an appeal. An appeal may be withdrawn as to any or all issues involved in the appeal. (b) Filing. (1) Form and content. Except for appeals withdrawn on the record at a hearing, appeal withdrawals must be in writing. They must include the name of the veteran, the name of the claimant or appellant if other than the veteran (e.g., a veteran's survivor, a guardian, or a fiduciary appointed to receive VA benefits on an individual's behalf), the applicable Department of Veterans Affairs file number, and a statement that the appeal is withdrawn. If the appeal involves multiple issues, the withdrawal must specify that the appeal is withdrawn in its entirety, or list the issue(s) withdrawn from the appeal. (2) Where to file. Appeal withdrawals should be filed with the agency of original jurisdiction until the appellant or representative filing the withdrawal receives notice that the appeal has been transferred to the Board. Thereafter, file the withdrawal at the following address: Director, Office of Management, Planning and Analysis (014), Board of Veterans' Appeals, P.O. Box 27063, Washington, DC 20038. (3) When effective. Until the appeal is transferred to the Board, an appeal withdrawal is effective when received by the agency of original jurisdiction. Thereafter, it is not effective until received by the Board. A withdrawal received by the Board after the Board issues a final decision under Rule 1100(a) (§ 20.1100(a) of this part) will not be effective. (c) Effect of filing. Withdrawal of an appeal will be deemed a withdrawal of the Notice of Disagreement and, if filed, the Substantive Appeal, as to all issues to which the withdrawal applies. Withdrawal does not preclude filing a new Notice of Disagreement and, after a Statement of the Case is issued, a new Substantive Appeal, as to any issue withdrawn, provided such filings would be timely under these rules if the appeal withdrawn had never been filed. The law was clear that when an appeal involves multiple issues, the withdrawal must specify that the appeal is withdrawn in its entirety or list the issue(s) withdrawn from the appeal, which was not done in this case. Specifically, the Veteran's attorney submitted a statement that the Veteran was withdrawing her appeal as to her increased rating for PTSD, without specification as to if she was withdrawing the reduction of major depression and PTSD rating from 100 percent to 50 percent stemming from her appeal of the February 2014 rating decision or the March 2014 NOD as to the February 2015 rating decision that increased the rating for major depression and PTSD to 70 percent. See Peyton v. Derwinski, 1 Vet. App. 282, 286 (1991) ("This is a rating reduction case, not a rating increase case."). In addition, after the appeal was transferred to the Board in April 2017, a withdrawal of an appeal should be addressed to the Board. However, as contended by the Veteran's attorney, the March 2018 withdrawal statement was addressed to the RO, which supports the contention that the Veteran's withdrawal was related to the increased rating claim for PTSD higher than 70 percent pending before the RO, as opposed to the appeal of the reduction of the major depression and PTSD rating in the February 2014 rating decision that was appealed and transferred to the Board at that time. Therefore, as it was unclear which issues were being withdrawn and the March 2018 withdrawal statement was addressed to the RO, the Board misapplied VA's regulation requiring specificity mandated by § 20.204(b). Thus, the Board finds that the legal framework, to include statutory and regulatory provisions extant at the time were incorrectly applied, the error was "undebatable" and the sort which, had it not been made, would have manifestly changed the outcome at the time it was made, which was to address the reduction claim on its merits. Based on the foregoing, the Board concludes that there was clear and unmistakable error in the June 2018 Board decision, and the motion is granted. The Board will therefore address the merits of the issues according to the law extant at the time of the June 2018 Board decision, below. 2. Entitlement to restoration of a 100 percent disability rating for major depression and PTSD. The Veteran contends that in effectuating the reduction of the major depression and PTSD, the RO did not comply with 3.343 (a) and 3.444(a). Regarding 3.444(a), the Veteran's attorney contends the evidence did not support a reduction and that a 100 percent rating should thus be restored. The attorney pointed out that the August 2012 VA examiner noted the Veteran had symptoms of depression, panic attacks, chronic sleep impairment, and mood and motivation disturbances. The attorney contends that the GAF score of 45 supports a continued 100 percent rating for psychiatric symptoms and that the December 2014 military physical evaluation board (PEB) determined that the Veteran's symptoms had not improved with treatment and was recommended for discharge. The Veteran also notes that the January 2014 letter from Dr. Gilboy documented that the Veteran had not shown sustained improvement. Regarding 3.343(a), the Veteran contends the RO failed to show clear evidence that any improvement in the Veteran's condition was material in conjunction with all of the facts of record. The Veteran contends that the December 2014 VA examination report documented that her mental condition continued to be a significant impediment to work. Accordingly, the Veteran contends the reduction should be void ab initio. The provisions of 38 C.F.R. § 3.343 apply in this case since the disability rating is going from a total rating to a partial rating. Under 38 C.F.R. § 3.343, a total disability rating will not be reduced "without examination showing material improvement in physical or material condition. Examination reports showing material improvement must be evaluated in consideration with all the facts of record, and consideration must be given particularly to whether the veteran attained improvement under the ordinary conditions of life, i.e. while working or actively seeking work, or whether the symptoms have been brought under control by prolonged rest, or generally, by following a regimen which precludes work, and, if the latter, reduction from total disability ratings will not be considered pending reexamination after a period of employment (3 to 6 months)." At the time that the rating reduction became effective, the 100 percent rating for major depression and PTSD had been continuously in effect for more than five years. Accordingly, the provisions of 38 C.F.R. § 3.344 apply. Under the provisions of 38 C.F.R. § 3.344, which addresses when evaluations may be reduced, the Board must consider whether the facts actually reflect an improvement in the veteran's ability to function under the ordinary conditions of life and work. Additionally, there must be material improvement in the disability before there is any rating reduction. In such cases, the provisions of 38 C.F.R. § 3.344(a), (b) are for application. Ratings on account of diseases subject to temporary or episodic improvement will not be reduced on any one examination, except in those instances where all the evidence of record clearly warrants the conclusion that sustained improvement has been demonstrated. See Peyton v. Derwinski, 1 Vet. App. 282, 286-87 (1992). Thus, for disabilities that have continued for five years or more, the issue is whether material improvement in a veteran's disability was demonstrated in order to warrant a reduction in such compensation benefits where the evidence makes it reasonably certain that the improvement will be maintained under the ordinary conditions of life. See Kitchens v. Brown, 7 Vet. App. 320 (1995); Brown v. Brown, 5 Vet. App. 413 (1993). In such cases examinations less full and complete than those on which payments were authorized will not be used as the basis for reductions. 38 C.F.R. § 3.344(a). The applicable legal standard summarized in Sorakubo v. Principi, 16 Vet. App. 120 (2002), requires that in the case of a rating reduction, the record must establish that a rating reduction is warranted by a preponderance of the evidence and that the reduction was in compliance with 38 C.F.R. § 3.344. See Brown, supra; see also Kitchens, supra. The Veteran's major depression and PTSD is currently rated under 38 C.F.R. § 4.130, Diagnostic Code 9411-9434. The actual criteria for rating psychiatric disabilities other than eating disorders are set forth in a General Rating Formula for Mental Disorders (General Rating Formula). Under this Diagnostic Code, a 30 percent disability rating is warranted when there is occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events). 38 C.F.R. § 4.130, Diagnostic Code 9411-9434. A 50 percent disability rating 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; difficulty in establishing and maintaining effective work and social relationships. 38 C.F.R. § 4.130, Diagnostic 9411-9434. Under the formula, a 70 percent rating 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; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately, and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); inability to establish and maintain effective relationships. 38 C.F.R. § 4.130, Diagnostic Code 9411-9434. A 100 percent rating is warranted for total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication, persistent delusions or hallucinations, grossly inappropriate behavior, persistent danger of hurting self or others, intermittent ability 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. 38 C.F.R. § 4.130, General Rating Formula for Mental Disorders. The United States Court of Appeals for the Federal Circuit has held that an evaluation under 38 C.F.R. § 4.130 is "symptom-driven," meaning that "symptomatology should be the fact-finder's primary focus when deciding entitlement to a given disability rating." Vasquez-Claudio v. Shinseki, 713 F3d 112, 116-17 (Fed. Cir. 2013). The symptoms listed are not exhaustive, but rather, "serve as examples of the type and degree of symptom, or their effects, that would justify a particular rating." Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). In the context of determining whether a higher disability evaluation is warranted, the analysis requires considering "not only the presence of certain symptoms[,] but also that those symptoms have caused occupational and social impairment in most of the referenced areas" i.e., "the regulation . . . requires an ultimate factual conclusion as to the veteran's level of impairment in 'most areas.'" Vasquez-Claudio, 713 F.3d at 11718; 38 C.F.R. § 4.130, Diagnostic Code 9411. Further, when evaluating a mental disorder, the Board must consider the "frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the veteran's capacity for adjustment during periods of remission." 38 C.F.R. § 4.126(a). A review of the record shows the Veteran's major depression and PTSD symptoms materially and sustainably improved so as to warrant a reduction from 100 percent to 70 percent for the service-connected disability. The reasons follow. The RO, in February 2014, as well as in the June 2014 reconsideration decision, and the February 2015 SOC, articulated an evidentiary basis for concluding that the requirements of 38 C.F.R. § 3.343 and 3.344 were met, such as to impose a reduction of a rating that had been in effect for more than five years. Notably, in the February 2015 SOC, the RO found that the overall evidentiary record showed that the severity of the Veteran's major depression and PTSD had materially and sustainably improved so that her disability picture more nearly approximated the criteria for a 70 percent rating based on findings of occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking or mood. The Board agrees with this finding. The Veteran's 100 percent rating in February 2008 was granted based, in large part, due to the Veteran's hospitalization for multiple suicide attempts. In February 2008, the Veteran was admitted for pill overdose and transferred to psychiatry for further treatment. The treating physician did not feel that it was safe for the Veteran to go home because she had overdosed twice in the past week and endorsed suicidal ideation, and she did not feel safe to go home earlier that morning, and she had poor insight and judgment. The Veteran was encouraged to stay to be seen by the attending psychiatrist in the morning, and the Veteran vehemently wanted to leave, became increasingly angry, and set off the fire alarm. The Veteran was placed on hold due to being a danger to herself. The RO noted that in February 2008, Global Assessment of Functioning (GAF) score was documented to be 35, which score is indictive of some impairment in reality testing or communication or major impairment in several areas, such as work or school, family, judgment, thinking or mood. The RO explained since there was a likelihood of improvement, the assigned evaluation was not considered permanent and was subject to a future review examination. The Veteran had two additional suicide attempts between 2008 to 2009 and an April 2010 rating decision continued the rating for a 100 percent based on the suicide attempt in 2009. Since the 100 percent rating for major depression and PTSD was granted, the Veteran has attended numerous VA treatment appointments and examinations, military and SSA examinations, all of which show that the Veteran's symptoms have materially and sustainably improved since the February 2008 rating decision. For example, March 2010 VA treatment records document the Veteran reported improvement in symptoms and that she was satisfied with her progress. She was attending a university for a program in counseling. She was described as in good spirits. An April 2010 VA treatment record noted the Veteran was a low risk for suicide. A June 2010 VA treatment record noted she was enrolled in college for speech from June 2010 to August 2010. A July 2010 VA treatment record documented the Veteran had not had a psychiatric admission since March 2009 and appeared to be stable and her current VA Providers at Long Beach and Loma Linda had been notified of the flag removal. An August 2010 Psychiatric Fitness for Duty Evaluation noted the Veteran's coping skills and multiple life stressors, which included her husband unemployed, financial concerns, son in hospital, friend living with her, attending college courses, and somatic complaints. The examiner noted that between college credits and assisting in her son's little league, she showed improvement in symptoms; however, she remained reliant on her therapist. The Veteran reported that she can do things with assistance. She reported that she needed assistance to go shopping and avoided pumping gas. She reported she assisted in her son's little leagues and was attending college courses online. She reported she was married with four children (ages.11, 10, 7, and just under 2). The examiner noted the Veteran's hygiene and grooming were adequate. Regarding her behavior, the examiner noted she arrived on time for her appointment, she was calm with socially appropriate behavior, although occasionally tearful. The examiner wrote were no behavioral indications of psychomotor agitation or retardation, hypervigilance, exaggerated startle response, or panic attacks noted. The examiner noted the Veteran endorsed recent passive suicidal ideation, but she did not have suicidal ideations at the time. Mental status examination was normal. The Veteran denied experiencing hallucinations and delusional thoughts, and there was no clinical evidence of psychosis at that time. The Veteran reported a history of auditory hallucinations. She denied experiencing any racing thoughts, expansiveness, or flight of ideas, and there was no clinical evidence of mania. The examiner explained the Veteran's general fund of knowledge was age and experience appropriate. Based on the Veteran's self-report and behavioral observation, the examiner concluded her memory was grossly intact (both short and long-term), attention and concentration were adequate for the interview, judgment was good, given her willingness to participate in the assessment, and insight was fair. The examiner noted a Feinstein mental status examination score of 29/30 suggested no gross impairments in higher cortical functioning and estimated intelligence level was average. The examiner noted the Veteran's impulse control was good. The Veteran reported panic attacks three times per week, when startled, reminded of deployment, or when driving next to big trucks; as a result, she reported she did not drive herself or pump gas. However, the examiner noted these panic attacks do not meet criteria for a panic attack as defined by the DSM-IV-TR (which was the DSM in effect at that time). The examiner noted the Veteran had been doing better until she had to come to Fort Lewis for evaluation and that she stopped taking her medication due to side effects. Regarding impact on occupational and/or social functioning, the examiner noted the Veteran refused to do things on her own, which caused moderate social and occupational impairment, sleep impairment, as the Veteran reported that it took her an hour or two to fall asleep at night, every night. The Veteran reported she sometimes oversleeps in the morning. The Veteran reported minimal impact due to sleep problems. The Veteran reported she helped take her children to school in the morning and attended college through online courses. The examiner noted that other symptoms included depression, anhedonia, low energy, low motivation, hopelessness, and guilt. The examiner documented depression was an ongoing problem, which resulted in decreased motivation, and it appeared to have a moderate impact on the Veteran's social and occupational functioning. The examiner explained the Veteran had previously been diagnosed with PTSD, but the Veteran's symptoms appear to be better accounted for by Major Depressive Disorder, severe, in partial remission, psychosocial stress, and Borderline Personality Disorder (BPD). The examiner explained nightmares reported by the Veteran were not combat-related, the avoidance and numbing symptoms were likely the result of interpersonal difficulties and mood symptoms, sleep and concentration problems were attributed to a diagnosis of major depression, and all other symptoms were considered either mild or not a problem. The examiner noted the Veteran had a lengthy history of depression, as evidenced by depressed mood, anhedonia, decreased concentration, decreased energy, fluctuating sleep, hopelessness, and increased guilt. The examiner noted the Veteran reported worry and anxiety attacks, however, the examiner explained the presence of repeated high levels of psychosocial stressors should be noted (e.g., domestic violence in marriages, financial concerns, legal concerns, and family problems). In addition, the examiner noted the diagnosis of BPD significantly contributed to the mood disturbance. The examiner explained the BPD had been previously diagnosed and continued to be evidenced by affective instability, impulsivity in substance use and spending, recurrent suicidal behavior, chronic feelings of emptiness, and inappropriate, and intense anger. The mental status examination documented the Veteran's judgment was good, no gross impairment, impulse control was good, recent passive suicidal ideation, panic attacks three times a week, sleep impairment, low motivation and moderate impact on social and occupational functioning. The Veteran reported she had been unable to work, felt ill all of the time, and had minimal motivation to engage in leisure activities. She reported she was able to push herself to engage in social and academic activities. The examiner explained BPD and high levels of psychosocial stress are likely responsible for the majority of impairment and her prognosis was limited due to BPD. In the June 2011 SSA functional report completed by the Veteran, she reported that on a typical day, she performs hygiene activities, takes medicine, attends any appointments, drives with spouse to take children to school, reads book, uses the computer, prepares her own meals about twice a week, and needs reminders to take medications. She reported she had extreme anxiety that caused her to cry and shake, which prevented her from making daily meals. She reported she took the trash out, vacuumed, made the bed, and did the laundry. She reported she shopped for groceries with her husband and engaged in online shopping to buy books. She reported she was able to pay bills, count change, use checkbook/money orders, but that she overspends. She reported that she enjoyed reading self-help books, watching television, and playing games. Regarding social activities, she reported she talks to others on the phone and chats online, about every other day. She reported she attended the Vet Center once a week with her spouse. In the June 2011 SSA functional report completed by the Veteran's husband, he explained that on a typical day, the Veteran read books, used the computer, performed daily hygiene, ate meals, watched movies, and attended family therapy and individual and group counseling. He reported she takes care of the children with his assistance and that he also helps with preparing meals, household chores, children's schoolwork and taking children to activities. He reported she was able to work and do these activities without assistance before her illness/conditions. He reported the Veteran had insomnia, nightmares, night tremors, night terrors, and restless sleep. Regarding personal care, the Veteran's husband reported she needs assistance with taking medication, preparing food, assistance and reminders for grooming, and getting in and out of a bathtub. He reported the Veteran assisted with laundry, vacuuming, grocery shopping, she is able to drive, ride in a car, and has panic attacks when in crowds or driving at night. He also reported the Veteran needs assistance with money management and her hobbies include playing games and watching television. He explained the Veteran has trouble keeping friends, avoids contact with neighbors, and had problems with emotional and verbal outbursts. He reported her condition affected her balance problems and ability to stand, memory, completing tasks, concentration, understanding, following instructions, and getting along with others. The Veteran's husband reported the Veteran had not been able to work since her illness and she has minimal ability to manage stressful situations without the aid of prescribed medications. He reported she met all requirements for a VA caregiver. In the 2011 SSA documents, the findings of fact and analysis of evidence section notes the Veteran needs assistance and reminders with grooming. She can make easy meals, do light housework, drive, shop with assistance, count change, unable to pay bills, and has issues with standing, memory, completing tasks, concentration, understanding, following instructions, and getting along others. It was noted the Veteran can become defensive and aggressive with authority figures. At the September 2011 psychiatric evaluation, when asked to describe her usual daily activity, the Veteran reported she helped get her kids ready for school, took her husband to work, conducted light chores at home, read, performed hygiene, and attended VA group meetings. She reported she bathed and dressed without assistance, but she does not manage her own money. She reported having fair relationships with family and poor relationships with friends. The Veteran denied suicidal or homicidal plans or thoughts. The examiner noted the Veteran did not exhibit looseness of association, thought disorganization, flight of ideas, thought blocking, tangentiality or circumstantiality. She had no delusions, denied phobias, obsessions, derealization, and depersonalization. She denied auditory and visual hallucinations. She was oriented to time, place, person, and purpose. A GAF score of 60 was assigned. The SSA examiner explained the MSE shows the Veteran's ability to follow simple oral and written instructions was mildly limited, ability to follow detailed instructions was moderately limited due to difficult focusing on tasks. The examiner noted the Veteran's ability to comply with job rules, such as safety and attendance was moderately limited, ability to respond to changes in routine work setting was moderately limited due to depression and low motivation, ability to respond to work pressure in a usual working setting was moderately limited due to depression and nervousness, and daily activities were moderately limited. The examiner noted progress is guarded. The examiner noted the Veteran had moderate issues in "CPP and social functions." The examiner explained impairment diagnoses were affective disorder, anxiety disorders, drugs and substance addiction disorders. The examiner noted restriction of activities of daily living was mild, difficulties in maintaining social functioning was moderate, and difficulties in maintaining concentration, persistence, or pace was moderate. The examiner noted the Veteran's statements about the intensity, persistence, and functionally limiting effects of the symptoms was not substantiated by the objective medical evidence alone. It was determined that the Veteran was partially credible. The examiner found the Veteran's ability to remember locations, work-like procedures, ability to understand and remember very short and simple instructions were not significantly limited, ability to understand and remember detailed instructions was moderately limited, and she had concentration and persistence limitations. The examiner noted the Veteran had moderate limitations in ability to carry out detailed instructions, maintain attention and concentration for extended periods, perform activities within a schedule, maintain regular attendance, punctuality, ability to sustain an ordinary routine without special supervision, and ability to work in coordination with or in proximity to others without being distracted by them. The examiner concluded the Veteran's ability to make simple work-related decisions was not significantly limited. The examiner noted she had moderate limitations in her ability to complete a normal workday and workweek without interruptions from psychological symptoms and to perform at a consistent pace without an unreasonable number and length of rest periods, ability to interact appropriately with the general public, ability to get along with coworkers or peers without distracting them or exhibiting behavioral extremes, ability to respond appropriate to changes in the work setting, ability to set realistic goals or make plans independently of others. The examiner explained the Veteran had no significant limitations as to her ability to ask simple questions or request assistance, accept instructions and respond appropriate to criticism from supervisors, ability to maintain socially appropriate behavior and to adhere to basic standards of neatness and cleanliness. Regarding the Veteran's work history, she reported she worked as an in-home care provider from August 2006 to May 2009. The examiner noted she was limited to unskilled work because of her impairments. It was noted the Veteran has some limitations in her ability to perform work related activities but that she is capable of performing work that is less demanding. The SSA determined that her condition is not severe enough to keep her from working. A January 2012 VA treatment record documented the Veteran reported she is successfully coping with her catastrophic thinking. She reported she struggled to listen and this was addressed as it would have a negative impact on her ability to be a therapist (currently in MA program), as a wife, mother, etc. A May 2012 VA treatment record noted the Veteran received her bachelor's degree and was now enrolled in a master's program. The Veteran was noted as doing well but emotional and tearful, and exhibited effective coping, and she was open and non-defensive. The clinician noted the Veteran's chronic symptoms of PTSD included anxiety and low frustration tolerance. The Veteran reported she was planning on doing prolonged exposure therapy with Dr. Gilboy. The Veteran reported she was experiencing stress related to her 13-year-old son, who had been in a residential facility but eventually lost his bed. She reported she has to go to family court several times and feels overwhelmed. She reported nightmares responsive to prazosin, appetite was ok, she experienced weight gain, and no new changes were reported. She reported she was compliant with psychiatric medications. A GAF score of 46 was assigned. An August 2012 VA PTSD examination report documents the examiner noted diagnoses of PTSD and depressive disorder and noted that the symptoms of the conditions overlap, exacerbate each other and are otherwise intertwined. The examiner noted the Veteran's symptoms included depressed mood, anxiety, panic attacks that occur weekly, chronic sleep impairment, and disturbances of motivation and mood, and resulted in occupational and social impairment with reduced reliability and productivity. The Veteran reported she was not employed at that time, and she had a pending military medical board. The examiner noted a 2009 VA treatment record documented a GAF score of 42 and a 2012 VA treatment record noted a GAF score of 46 and that she was taking several medications for her psychiatric symptoms. The Veteran reported receiving a bachelor's degree in psychology and that she was pursuing her master's degree in psychology. It was noted the Veteran was capable of managing her own financial affairs. A September 2012 Medical Evaluation Board (MEB) noted the Veteran was diagnosed with major depression and obtained treatment for alcohol and substance abuse co-occurring disorder from November 2007 until March 2009. The examiner noted the Veteran was treated for PTSD from 2007 to 2009, to include four suicide attempts. Regarding major depression, the examiner noted it was single episode, severe, in partial remission, symptoms noted to include depressed mood, anhedonia, guilt, decreased concentration, sleep disturbance, and hopelessness. The examiner noted the Veteran's impairment was mild and resulted in occupational and social impairment due to mild or transient symptoms which decreased work efficiency and ability to perform occupational tasks only during periods of significant stress or symptoms controlled by continuous medication. A GAF 51-60 was assigned. She was found as unsuitable for service due to her personality disorder and her prognosis was poor. The examiner noted she was in treatment since November 2007 and symptoms persist and drug abuse continues. She was determined to be not fit for duty because of psychological condition that required significant duty limitations in a protected environment and continued service may compromise health and or well-being of other soldiers. The Veteran was placed on permanent profile and the Veteran reported she had been unable to work, feels ill all the time, and has minimal motivation to engage in leisure activities, and she is able to push herself to engage in social and academic activities. The examiner explained co-morbid BPD and high levels of psychosocial stress are likely responsible for the majority of impairment at this time and BPD makes her unsuitable for service. The examiner further explained PTSD symptoms appear to be better accounted for by major depression can account for low energy level, depressed mood with tearfulness, anhedonia, low self-esteem, poor concentration and recurrent suicidal ideations. The examiner explained research shows that in the majority of cases of major depression, symptoms completely remit and functioning returns to the premorbid level and that BPD makes Veteran truly dysfunctional due to maladaptive thinking and behavior (self-destructiveness, angry disruptions in close relationships and chronic feelings of deep emptiness and loneliness). He explained BPD pattern of instability with serious affective and impulsive dyscontrol with symptoms are greatest in young adulthood and more advanced with age. The examiner noted treatment of PTSD cannot hurt but could delay treatment of the most disabling condition of BPD, and that the diagnosis of BPD was supported by suicidal ideations, suicide attempts, multiple marriages, domestic violence, disrupted academic and occupational functioning. In a November 2012 VA treatment record, the Veteran reported stress over the Medical Board finding with Army because the military refuses to accept her diagnosis of PTSD due to MST and wants to blame her condition on borderline personality disorder. The Veteran reported being overwhelmed with stress and feeling like she's clinging on a "shoelace." She reported feeling overwhelmed with stress. She denied suicidal ideations and expressed thoughts that medications were helping but would like to stop medication. She reported she can tell the difference when she does not take it. She reported intrusive recollections and flashbacks of military rape, nightmares of military rape which occurred when she was sleeping, someone tossing her a pillow triggered autonomic reactivity and flashbacks; appetite, weight, energy, and no new changes were reported. Regarding PTSD, the physician noted significant psychosocial stressors and reviewed military psychiatric assessment and Dr. Gilboy's letter to the MEB. The physician explained that he and Dr. Gilboy did not agree that the Veteran had borderline personality disorder. (Dr. Gilboy did not think the Veteran had such diagnosis.) A GAF score of 30 was assigned. In an October 2012 memorandum for PEB, the examiner noted symptoms of avoidance and that numbing symptoms were likely due to interpersonal difficulties, mood symptoms, sleep and concentration problems attributed to major depression, and all other problems were mild or not a problem. The physician explained the presence of repeated high levels of psychosocial stressors should be noted, to include domestic violence in marriages, financial and legal concerns, and family problems. In addition, the examiner explained the diagnosis of BPD significantly contributed to the mood disturbance in the Veteran's clinical presentation. The examiner reiterated findings of the previous military evaluations. An April 2013 VA treatment record noted the Veteran's case management services was moved from Quarterly to Semi-Annual, as the Veteran had stable housing, income, transportation and social support for longer than the duration of one year. The Veteran denied suicidal and homicidal ideations. A November 2012 Memorandum PEB reiterated the previous findings from prior evaluations. It again noted major depression was in partial remission, psychosocial stressors, borderline personality disorder continues to be evidenced by recurrent suicidal behavior, feeling empty, intense anger, impulsivity in substance use and spending, and instability. The examiner concluded symptoms resulted in occupational and social impairment due to mild or transient symptoms, which decrease work efficiency and ability to perform occupational tasks. A GAF score of 51-60 for moderate symptoms was assigned. An August 2013 VA treatment record reflects the Veteran reported she is at a point in her life where she would like to deal with some of her issues. She reported that she had to come to terms with several traumas that have happened to her and how she feels about these traumas. The Veteran discussed wanting to be more involved in her children's lives but feeling disconnected at times and with her husband. She reported her past trauma impacted her relationship with family members and affected her ability to trust others. She was noted as alert, oriented times four. Speech rate/volume/rhythm were noted as normal. The Veteran's mood was dysphoric and affect was congruent. She denied current suicidal or homicidal ideations. The clinician noted the Veteran had a good support system and appeared to be a low risk for suicide at that time. A September 2013 VA treatment record documents the Veteran reported being stressed. She was attending school and working on her practicum and has a household with 5 children. She reported being upset about her older son getting in a fight at school and being suspended for 30 days. She discussed feeling frustrated with multiple issues and feeling like her chest is tight all the time due to anxiety. She reported there was tension in her relationship with her husband and wanting to address that in couple therapy before it turns into a bigger issue. The Veteran reported that her and her husband communicate better in counseling compared to being at home. She reported having chest pain, anxiety, feeling overwhelmed and depressed at times. Mental status examination documented she was alert, oriented times four. Speech rate/volume/rhythm were normal, mood was dysphoric, and affect was congruent. She denied having suicidal and homicidal ideations. The Veteran contacted the SPC Hotline in October 2013 due to an increase in stressors of work, full-time school, part-time internship, family, and past traumas. The Veteran was contacted by a Loma Linda VAMC SPC Coordinator who assisted Veteran with re-connecting to Mental Health for medication management and VA treatment. October 2013 VA treatment records document the Veteran reported she felt overwhelmed and was not meeting her work deadlines and having issues with her family. She reported her last suicidal ideation was in 2010. The Veteran was noted to be under a lot of stress with spouse, kids, and school. She reported issues with her husband, including accusations of infidelity against her, and her husband had talked negatively to her son. Her mood was very depressed, and she tired easily. A GAF score of 40 was assigned. The Veteran reported that she communicated more with friends when she felt overwhelmed. She also discussed the anniversary of her MST coming up and having issues dealing with that memory. She reported her husband and children were her strong support. A January 2014 VA treatment record documents the Veteran reported multiple stressors and ongoing symptoms of anxiety and depression. The Veteran reported she contemplated quitting school at one point. She reported feeling overwhelmed at times due to home situations. Mental status examination revealed she was alert, oriented x4, speech rate/volume/rhythm normal, mood was dysphoric, and affect congruent. The Veteran denied current suicidal and homicidal ideations and has a good support system. The Veteran was noted to be at low risk for suicide at that time. A January 2014 letter from Dr. Gilboy from the VA Outpatient clinic explained the Veteran's symptoms of PTSD and major depression caused occupational impairment. The physician explained that due to the pervasive and vacillating nature of the symptoms' presentation and the clinician's inability to forensically determine occupational impairments with specificity, it is not possible to provide definitive answers. He explained that it can be said with confidence that the Veteran's depression has a negative impact on her memory, concentration, and ability to persevere and that her PTSD impairs her frustration tolerance, increase irritability, and essentially 'shorten her fuse' for becoming reactionary to stress. He explained her progress with symptom remediation had been tenuous and she made gains in some areas, yet still prone to feeling overwhelmed in her environment. He explained the symptom of avoidance has gotten in the way of her treatment as well as social environment stressors and that she not shown sustained improvement based on objective tests (PCL, BDI2) and clinical observation and that the clinician had seen the Veteran on 62 occasions between April 2010 and May 2013. In the June 2014 Memorandum for reconsideration of the reduction, the Decision Review Officer (DRO) explained that between 2012 and 2014, the Veteran reported feeling depressed, anxious, and overwhelmed with work deadlines, and school and marital discord. The DRO noted mini-mental examinations showed that the Veteran was alert and oriented, speech, volume, and rhythm were regular. The Veteran's mood was dysphoric, and affect was congruent with her mood. The physician noted the Veteran did not have suicidal or homicidal ideations, hallucinations or delusions, and had a good support system. The DRO explained the August 2012 VA/DoD examination was significant for depressed mood, anxiety, panic attacks that occurred weekly or less often, chronic sleep impairment, and disturbance in motivation and mood. The DRO concluded the evidence shows that the Veteran had not been hospitalized or had suicidal thoughts since 2009 and she was currently working full-time, attending school full-time, and raising children. The DRO explained the Veteran had marital discord, was functioning with a high amount of stress, and was overwhelmed at times with significant anxiety and depressed mood. The DRO explained that the evidence shows that the Veteran was not hospitalized or had suicidal thoughts since 2009 and does not show that her impairment is higher than the criteria shown for the 50 percent evaluation. In a December 2014 VA PTSD Disability Benefits Questionnaire, the examiner noted diagnoses of PTSD and major depression and that the Veteran symptoms of PTSD include physical triggers, avoidance, anhedonia, detachment, restricted range of affect, sleep and concentration disturbances, anger, hypervigilance, and an exaggerated startle response. The examiner noted the Veteran's symptoms of depression include depressed mood, fatigue, anhedonia, and sleep and appetite disturbances. The examiner found the Veteran had occupational and social impairment with reduced reliability and productivity. The examiner opined that there appears to be moderate social and occupational impairment due to her PTSD. The Veteran reported she had been married for 6 years to her second husband and that she was unemployed. She reported she previously worked as a customer service representative for a mortgage company. She reported no problems with her co-workers or supervisor. The Veteran reported no disciplinary actions during her employment and had some work absences because of her psychiatric symptoms. The December 2014 examiner noted the Veteran had symptoms of depressed mood, anxiety, near continuous depression affecting the ability to function independently, appropriately and effectively, chronic sleep impairment, mild memory loss, flattened affect, disturbances in motivation and mood, difficulty in establishing and maintaining effective work and social relationships, difficulty in adapting to stressful circumstances, including work or work like setting. The examiner explained the Veteran was capable of managing her own financial affairs. The Veteran reported she was unemployed due to her PTSD and depressive symptoms. The examiner explained that the Veteran evidenced difficulties with depression, anxiety, sleep and memory disturbances and problems with social relationships which would likely be problematic in the work setting. The Veteran's attorney contends that the January 2014 VA letter from Dr. Gilboy explained that the Veteran's symptoms did not reflect sustained improvement. Dr. Gilboy appears to conclude that the Veteran's general psychiatric symptoms have not reflected sustained improvement, however, the physician does not specifically discuss why he made the conclusion that the Veteran's service-connected psychiatric disorder rating had not been sustainably improved from a 100 percent rating to a 70 percent rating. Further, Dr. Gilboy specifically found that the Veteran made some gains in some areas but is prone to feeling overwhelmed in her environment and the symptoms he described impacted her memory, concentration, and ability to persevere, which is consistent with a 70 percent rating. The Board finds the VA treatment records that document the Veteran's major depression and PTSD symptoms to be more probative of as to whether the Veteran's symptoms materially and sustainably improved, as they document consistent treatment over the course of a significant period of time, and the assessments of separate examiners, to include the 2011 SSA examiner, and MEB evaluators that generally reflect opposite conclusions as to the severity related to her PTSD and major depression. Accordingly, Dr. Gilboy's statement that the Veteran's symptoms have not sustainably improved is of limited probative value in consideration of the entire record, to include the Veteran's ability to obtain her bachelor's degree, work on her master's degree, and work in practicum and/or internship. The 2012 VA examiner had indicated that the Veteran's PTSD symptoms resulted in impairment of occupational or social impairment with reduced reliability and productivity, which is consistent with the 2011 SSA examination report that the Veteran's symptoms resulted in moderate impairment and assigned a GAF score of 60. The 2011 SSA examiner noted moderate limitations in the Veteran's ability to complete a normal workday and workweek without interruptions from psychological symptoms and to perform at a consistent pace without an unreasonable number and length of rest periods, ability to interact appropriately with the general public, ability to get along with coworkers or peers without distracting them or exhibiting behavioral extremes, ability to respond appropriate to changes in the work setting, ability to set realistic goals or make plans independently of others. The Veteran was found to have no significant limitations as to her ability to ask simple questions or request assistance, accept instructions and respond appropriate to criticism from supervisors, ability to maintain socially appropriate behavior and to adhere to basic standards of neatness and cleanliness. As detailed above, the VA treatment records beginning in 2010 consistently document the following symptoms: nightmares and disturbed sleep, poor concentration, and flashbacks; treatment providers consistently documenting that the Veteran exhibited good hygiene and was fully oriented, her speech was normal and coherent, her thoughts were goal directed with normal content, and her insight and judgement were good. It was also noted that the Veteran's mood was depressed due to her family stressors, to include court issues regarding custody issues with her ex-husband, financial issues, and parenting issues. The Veteran's treatment notes also document that she regularly attended group and individual therapy throughout this time and had a supportive husband and family. Although an August 2010 mental status documented recent passive suicidal ideation, she reported no intent, judgment was good, there was no gross impairment, and impulse control was good. The VA treatment records regularly document that the Veteran did not endorse or display behaviors consistent with suicidal ideation or danger of hurting herself throughout the vast majority of her VA treatment records. Specifically, the Veteran reported no thoughts or denied suicidal ideations on a regular basis from August 2010 to 2014. The Board finds the VA treatment records, which, again, do not document that the Veteran reported consistent suicidal ideation, but rather document that the Veteran, more often than not, specifically denied suicidal ideation. The August 2010 Psychiatric Fitness for Duty Evaluation noted the Veteran's report of history of auditory hallucinations, however, the Veteran denied experiencing any racing thoughts, expansiveness, or flight of ideas, and there was no clinical evidence of mania. Her general fund of knowledge was age and experience appropriate. Based on her self-report and behavioral observation, her memory was considered grossly intact (both short and long-term); Attention and concentration were adequate, and judgment and insight were fair. There were no gross impairments in higher cortical functioning. The remainder of the VA treatment records do not document that the Veteran experienced hallucinations, and, as such, the Board finds that the preponderance of the evidence is against a finding that the Veteran experienced persistent hallucinations as contemplated by the 100 percent rating. The issue is whether the RO was proper in reducing the Veteran's evaluation at the time the RO proposed to reduce the evaluation in October 2013 and at the time the RO reduced the rating in February 2014. Thus, the Board looks to the symptoms the Veteran was reporting at those times to cause the RO to conclude that sustained improvement was shown in the Veteran's symptoms. As noted above, a 70 percent rating is warranted when a veteran displays occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately, and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); inability to establish and maintain effective relationships. The VA treatment records, SSA records, military MEB examinations, and VA examinations document the Veteran exhibited many of these symptoms. Furthermore, the Veteran's judgment and insight are consistently noted to be unimpaired, her affect, thought process, and speech were normal, alert and oriented. She did not have symptoms of the severity of frequency as required for a 100 percent rating for total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication, persistent delusions or hallucinations, grossly inappropriate behavior, persistent danger of hurting self or others, intermittent ability 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. Furthermore, as laid out above, the Veteran's symptoms have significantly improved since the last 2009 suicide attempt, as the Veteran was considered a low risk for suicide attempts, continued to deny suicidal ideations and intent, other than the 2010 instance of passive suicidal ideations, as evidenced by multiple VA examinations and VA treatment records, as well as SSA and military MEB records, from 2010 to 2014. The VA treatment records, SSA records, MEB records, and VA examinations provided a detailed overall disability picture of the Veteran's major depression and PTSD symptoms since at least 2010, which showed that the Veteran's disability had begun to improve at that time and had shown sustained and material improvement by the time of the 2012 VA examination. Thus, the improvement that began in 2010 was sustained by 2014, and the Board finds that this is evidence showing that the improved symptoms would be maintained under the ordinary conditions of life, as they had been improved since 2010, a four-year period. In that regard, as noted in the May 2012 VA treatment record, the Veteran obtained her bachelor's degree and continued in a master's program. Treatment records from 2012 to 2014 also document she attended school full-time and worked on her practicum and/or a part-time internship. Although the Veteran needed assistance with some activities of daily living, she was largely independent and had supportive relationships, to include her husband and children. Also, a September 2015 Report of General Information documents the Veteran indicated she wished to withdraw her claim for TDIU, as she had been working part-time and was offered a full-time position. In addition, the basis of the 100 percent schedular rating granted in 2008 was due to the Veteran's suicide attempts or persistent danger of hurting herself, however, since 2009, the Veteran was not a persistent danger to hurting herself. Accordingly, the reduction to a 50 percent rating from May 1, 2014, that was later increased to 70 percent, from that date, was proper. See February 2015 SOC and rating decision. Although the Veteran contends that the December 2014 VA examination report did not reflect sustained improvement, the examiner explained that the Veteran evidenced difficulties with depression, anxiety, sleep and memory disturbances and problems with social relationships that would likely be problematic in the work setting. The Board finds these symptoms and the severity of such symptoms are contemplated by the 70 percent rating. Further this examination was obtained after the effectuation of the reduction in the February 2014 rating decision. Again, if the Veteran feels that her disability is worse than the current 70 percent rating contemplates, she can file a formal claim for increase. Notably, the Veteran withdrew her pending appeal as to the claim for a higher rating than 70 percent for major depression and PTSD in March 2018. The Veteran further contends that the August 2012 VA examiner's assignment of a GAF score of 45 supports that the Veteran had serious symptoms under 100 percent rating, however, the August 2012 examiner did not assign a GAF score of 45, and rather noted that a 2009 VA treatment record documented a GAF score of 42 and a 2012 VA treatment record noted a GAF score of 46. The Board notes that GAF scores ranged from 30 to 60 from March 2012 to November 2013. GAF scores assigned in a case, like an examiner's assessment of the severity of a condition, are not dispositive of the evaluation issue; rather, the GAF score must be considered in light of the actual symptoms of the Veteran's disability picture, which provide the primary basis for the rating assigned. See 38 C.F.R. § 4.126 (a). The Board notes that the, revised DSM-5, which among other things, eliminates GAF scores, applies to claims received or pending before the agency of original jurisdiction on or after the effective date of this interim final rule on, August 4, 2014. See 79 Fed. Reg. 45,093 (Aug. 4, 2014). Nonetheless, despite the GAF score of 30 in the May 2012 VA treatment record and GAF score of 46 in May 2012, review of the reported symptomatology reveals that the Veteran's symptoms were indicative of moderate to serious symptomatology, as contemplated by the assigned 70 percent rating. Additionally, the Board reiterates that it is the symptoms shown, and not an assigned GAF score or an examiner's assessment of the severity of a disability, which provides the basis for the assigned rating. See 38 C.F.R. § 4.126(a). Based on the foregoing, the Board finds that the major depression and PTSD symptoms have shown sustained and material improvement that the Veteran has maintained under ordinary conditions of life since the assignment of the 70 percent rating, as evidenced by the reported symptoms in the extensive treatment records beginning in 2010. The Veteran's major depression and PTSD symptoms as noted in the 2011 SSA examination, August 2012 VA examination, and thereafter, began to show improvement. Four years later in 2014, the Veteran's symptoms had shown sustained and material improvement. The Veteran underwent multiple examinations, to include the August 2010 physical fitness evaluation, September 2011 SSA examination, August 2012 VA examination, 2012 MEB evaluation, which all showed material and sustained improvement of the Veteran's major depression and PTSD symptoms. Thus, the improved symptoms had been shown for four years, which the Board finds is indicative of sustained improvement under the ordinary conditions of life, as the improved symptoms were maintained during this four-year period of time, which the Board finds would be indicative of a disability being maintained under the ordinary conditions of life. There are multiple examination reports that were used to conclude that improvement had been shown, along with the VA treatment records, and the Board concludes that the examination reports relied upon to conclude improvement were as full and complete, as described above. The Board notes there is a discrepancy between whether the Veteran has a diagnosis of a personality disorder, however, the Veteran's VA clinicians indicated that the Veteran did not have a personality disorder. Where an examiner is unable to distinguish the symptoms of a service-connected disability from non-service connected manifestations, all the manifestations will be considered part of the service-connected disability. Mittleider v. West, 11 Vet. App. 181, 182 (1998) (citing Mitchem v. Brown, 9 Vet. App. 136, 140 (1996)). Nonetheless, the September and October 2012 MEB evaluations appear to explain the most disabling condition of BPD was supported by suicidal ideations, suicide attempts, multiple marriages, drug use, domestic violence, all of which were contemplated by the 100 percent rating prior to May 1, 2014, and the 70 percent rating thereafter. Regarding the symptoms of disrupted academic and occupational functioning caused by the BPD as noted by the MEB evaluations, the Board notes that the Veteran attended school full time and worked on her practicum and/or a part-time internship. Therefore, regardless of the validity of the diagnosis of BPD, the symptoms related to the psychiatric disability were contemplated by the 100 percent rating prior to May 1, 2014, and the 70 percent rating thereafter. The evidence does not show total social and occupational impairment, which is the level of severity contemplated by a 100 percent schedular rating. Accordingly, the Board finds that the disability rating reduction to 50 percent, effectuated by the rating decision in February 2014, which was later increased to 70 percent, was in accordance with the requirements of 38 C.F.R. § 3.344 (a) and (b), as there was sustained, material improvement in the Veteran's major depression and PTSD shown on multiple examinations and in VA treatment records. Thus, the 100 percent evaluation for major depression and PTSD is not restored. In short, major depression and PTSD disability shows sustained, material, and actual improvement in the ability to function under the ordinary conditions of life and work; a preponderance of the evidence shows that the reduction is warranted. See Faust v. West, 13 Vet. App. at 349. The preponderance of the evidence shows substantial improvement under the ordinary conditions of life. Because there has been substantial and material improvement, a restoration to 100 percent is not warranted. In many rating reduction cases, the Agency of Original Jurisdiction (AOJ) must first comply with several specific procedures described in 38 C.F.R. § 3.105(e). Where the reduction in evaluation of a service-connected disability or employability status is considered warranted and the lower evaluation would result in a reduction or discontinuance of compensation payments currently being made, a rating proposing the reduction or discontinuance and setting forth all material facts and reasons must be prepared. A veteran must be notified at his or her latest address of record of the contemplated action and furnished detailed reasons therefor and will be given 60 days for the presentation of additional evidence to show that compensation payments should be continued at their present level. A veteran must also be informed that he or she may request a predetermination hearing, provided that the request is received by VA within 30 days from the date of the notice. If additional evidence is not received within the 60-day period and no hearing is requested, final rating action will be taken and the award will be reduced or discontinued effective the last day of the month in which a 60-day period from the date of notice to the veteran expires. See 38 C.F.R. § 3.105(e). When a disability rating is reduced by the AOJ without following the applicable regulations, the reduction is void ab initio. See Greyzck v. West, 12 Vet. App. 288, 292 (1999). In contrast to the Veteran's contention, the record shows that the AOJ complied with the requirements of 38 C.F.R. § 3.105(e). Specifically, in addition to issuing an October 2013 rating decision proposing to reduce the disability rating for the Veteran's major depression and PTSD from 100 percent disabling to 50 percent disabling, the AOJ sent the Veteran a letter that complied with the requirements of 38 C.F.R. § 3.105(e). This letter informed the Veteran of the proposed action and that she could submit additional evidence and request a hearing within the applicable time periods. Thus, the Board finds there has been no due process violation in the reduction of the rating for major depression and PTSD. A. P. SIMPSON Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Sarah Campbell, 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.