Citation Nr: 21066592 Decision Date: 11/01/21 Archive Date: 11/01/21 DOCKET NO. 18-06 080 DATE: November 1, 2021 ORDER Entitlement to an initial rating greater than 70 percent disabling for an acquired psychiatric disorder, to include post-traumatic stress disorder (PTSD), is denied. Entitlement to an effective date prior to October 21, 2015, for service connection of an acquired psychiatric disorder, to include PTSD, is denied. FINDINGS OF FACT 1. A preponderance of the evidence is against a finding that the Veteran exhibits symptoms of total occupational and social impairment, including 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. 2. The Veteran did not submit a claim for disability compensation within one year after separation from active duty, nor did he submit a claim for disability compensation prior to October 21, 2015, for service connection of an acquired psychiatric disorder, to include PTSD. CONCLUSIONS OF LAW 1. The criteria for entitlement to an initial rating greater than 70 percent disabling for an acquired psychiatric disorder, to include PTSD, have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.321, 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code (DC) 9411. 2. The criteria for entitlement to an effective date prior to October 21, 2015, for service connection of an acquired psychiatric disorder, to include PTSD, have not been met. 38 U.S.C. §§ 501, 1110, 1155, 5107, 5110, 5111(a); 38 C.F.R. §§ 3.4, 3.31, 3.102, 3.400, 4.3, 4.126, 4.130, DC 9411. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the U.S. Navy from March 1967 to October 1968. This matter comes to the Board of Veterans' Appeals (Board) on appeal from June 2016, December 2017, and October 2020 rating decisions issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Reno, Nevada. In his January 2018 substantive appeal, the Veteran indicated, "I do not want an optional Board hearing." See January 2018 VA Form 9, Appeal to Board of Veterans' Appeals. The matters were remanded in April 2019 for "an additional VA examination to determine the nature and severity of the service-connected acquired psychiatric disability." See April 2019 BVA Decision. The matters are returned to the Board for further consideration. This case has been advanced on the docket pursuant to 38 U.S.C. § 7107(b) and 38 C.F.R. § 20.902(c). 1. Entitlement to an initial rating greater than 70 percent disabling for an acquired psychiatric disorder, to include PTSD. The Veteran contends that he is entitled to an increased rating for his acquired psychiatric disorder. See May 2017 VA Form 21-0958, Notice of Disagreement and January 2018 VA Form 9, Appeal to Board of Veterans' Appeals. Duty to Notify and Assist VA must notify the claimant of any information, including any medical or lay evidence, not previously provided to VA, that is necessary to substantiate the claim. See 38 U.S.C. § 5103 (2012); 38 C.F.R. § 3.159 (2017); see also Scott v. McDonald, 789 F.3d 1375 (Fed. Cir. 2015). VA has satisfied its duties to inform the Veteran in this case. See 38 U.S.C. §§ 5103, 5103A; 38 C.F.R. § 21.1032(a). The duty to notify was satisfied by January 2016 VA Form 21-526EZ, Application for Disability Compensation. See also June 2016 VA Rating Decision Narrative, December 2017 VA Rating Decision Narrative, January 2018 Statement of the Case, April 2019 BVA Decision, November 2019 VA Correspondence, October 2020 Supplemental Statement of the Case, and October 2020 VA Rating Decision Narrative. VA's duty to assist functions to aid a claimant in obtaining evidence necessary to substantiate a claim, but VA is not required to provide assistance to a claimant when there is no reasonable possibility that assistance would aid in substantiating the claim. See 38 U.S.C. § 5103A (2012). As for VA's assistance to the Veteran, service treatment records and VA treatment records were obtained and associated with the claims file and evidence of record. The Veteran has not identified any additional, outstanding records relevant to the claim decided herein. Further, the entire record was available to the June 2016 and December 2019 medical examiners, Initial PTSD examinations were performed, and the testing was sufficient to adequately address all potential rating criteria. See 38 U.S.C. § 7104(d)(1); 38 C.F.R. §§ 4.126, 4.130. Any defects identified in the June 2016 VA examination was cured by the December 2019 examination. See April 2019 BVA Decision. The Board finds that VA has done everything reasonably possible under 38 C.F.R. § 21.1032(a) and in keeping with principles of basic fairness, in the spirit of the non-adversarial nature of VA benefits adjudication, to assist the Veteran. See Gambill v. Shinseki, 576 F.3d 1307 (Fed. Cir. 2009) (quoting Prickett v. Nicholson, 20 Vet. App. 370, 382 (2006) ("[C]reating a procedural right in the name of fair process principles [for applicants for VA disability benefits] is primarily based on the underlying concept of the VA adjudicatory scheme, not the U.S. Constitution."). All pertinent due process requirements have been met. See 38 C.F.R. § 3.103 (2017). Further development and further assistance by VA are not warranted. The RO's efforts have substantially complied with the instructions contained in the April 2019 Board remand. See Stegall v. West, 11 Vet. App. 268 (1998). An additional remand for further development of this claim would serve no useful purpose. Accordingly, the Board finds that no prejudice to the Veteran will result from the adjudication of his claim in this Board decision. Initial Ratings Disability ratings are determined by the criteria set forth in the VA Schedule for Rating Disabilities and are intended to represent the average impairment of earning capacity resulting from the disability. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Disability ratings are based on an evaluation of all the evidence of record that bears on occupational and social impairment, rather than solely on the examiner's assessment of the level of disability at the moment of examination. 38 C.F.R. § 4.126. Where there is a question as to which of two evaluations shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. It is not expected that all cases will show all the findings specified; however, findings sufficiently characteristic to identify the disease and the disability therefrom and coordination of rating with impairment of function will be expected in all instances. 38 C.F.R. § 4.21. All reasonable doubt will be resolved in favor of the Veteran. 38 C.F.R. § 4.3. The Veteran's PTSD condition was evaluated under 38 C.F.R. § 4.130, DC 9411. The General Rating Formula for Mental Disorders at 38 C.F.R. § 4.130 provides the following ratings: A non-compensable rating is provided for a mental condition that has been formally diagnosed, but symptoms are not severe enough to interfere with occupational and social functioning or to require continuous medication. A 10 percent rating is given for occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms are controlled by continuous medication. A 30 percent rating is appropriate for 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). A 50 percent rating is assigned for 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. A 70 percent rating is warranted for occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately, and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work like setting); inability to establish and maintain effective relationships. A 100 percent rating reflects 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. See 38 C.F.R. § 4.130, Schedule of ratings mental disorders, General Rating Formula for Mental Disorders. When determining the appropriate disability evaluation under the general rating formula, the primary consideration is a Veteran's symptoms, but VA must also make findings as to how those symptoms impact the Veteran's occupational and social impairment. See Vazquez-Claudio v. Shinseki, 713 F.3d 112, 116-17 (Fed. Cir. 2013). A Veteran may only qualify for a given disability rating under the general rating formula by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration. Id at 117-18. The listed symptoms are not exhaustive but "serve as examples of the type and degree of symptoms, or their effects, that would justify a particular rating." See 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." See Vazquez-Claudio, supra; 38 C.F.R. § 4.130. Factual Background The Board has reviewed the evidence of record, with an emphasis on the evidence relevant to this appeal. While the Board is obligated to provide adequate reasons and bases in support of its decision, there is no need to discuss in detail every item of evidence contained in the record. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (holding that VA must review the entire record but does not have to discuss each piece of evidence). Therefore, the Board will summarize the relevant evidence where appropriate, and the Board's forthcoming analysis will focus on what the evidence does or does not show in support of the claim. A March 2013 VA treatment record cited: "Patient denies acute or current problems...Complete Review of Systems...Psych: No nervousness, tension, affect, depression, anxiety, inability to maintain attention, hallucinations, suicidal ideation, planning, or method...No history of...Suicide Attempts or Ideation...Social History: Married x 1: Children: 2. Education: 2 years of college. Employment: TV...Physical Examination: General Appearance: Alert and oriented x 3, well nourished, cooperative, no signs of acute / chronic disease...Psych: orientation: within normal limits to person, place, time; memory: remote / recent; attention: world backwards, 'serial 7s;' mood and thought perception within normal limits. Assessment: 1) Primary Diagnoses: Obesity; 2) Secondary Diagnoses: hypertension; 3) Additional Diagnoses: Hyperlipidemia." See March 2013 VA New Patient Note. Pursuant to a duty to assist, the Veteran was provided with a medical examination in June 2016. The examining psychologist reviewed the claims file and evidence of record in preparation for his report. The Veteran was examined in person, and his statements were considered, including reports of a 47-year marriage that was as "solid as a rock," 2 grown daughters with whom he had regular contact and good relationships, and regular contact with a few friends. Regarding employment, the Veteran stated that he has been "primarily retired since he was 50 years old because his businesses did very well, and he has not needed to work." He denied any history of legal or behavioral problems. The Veteran reported anxiety. Grooming and hygiene were observed to be good. Mental status was alert, and the Veteran was fluent in speech and logical in thought. He denied any current suicidal / homicidal ideation, plan, or intent. There were no indications of delusions, hallucinations, or other signs of frank psychosis. Insight and judgment were intact. While the Veteran did not meet the full DSM-5 criteria for a diagnosis of PTSD, he was diagnosed with Other Specified Trauma and Stressor-Related Disorder. Occupational and social impairment was determined by the examining psychologist as: "symptoms are not severe enough either to interfere with occupational and social functioning or to require continuous medication." See June 2016 VA Initial PTSD examination report. January 2017 VA treatment described: "History of Present Illness: Pleasant 70-year-old male with past medical history of...depression...States he has noticed that he is more forgetful, has a difficult time concentrating. Reports using Marijuana for anxiety and that he has found better relief than with Fluoxetine. Recently diagnosed with PTSD and has a class with Social Worker...Social History...Recently started using Marijuana and intends to continue...Physical Examination...Psych: Stable, in a good mood. Looks forward to daily activities. Self admits to having mild depression but feels stable. Has increased anxiety...Assessment and Plan: Anxiety and memory Possible due to Marijuana use. Does not want an MRI at this time, even though the change in memory is current and rapid. States 'maybe I am feeling lazy and not trying hard enough to remember.'" See January 2017 VA Primary Care E & M Note. VA mental health treatment in January 2017 detailed: "Per Primary Care Physician consult, 'anxiety, starting on fluoxetine, please follow [up]. Patient is also interested in psychology evaluation for anxiety. He would like one-to-one sessions; also is interested in anxiety / stress management classes'...[Veteran] is a 70-year-old...married, male. He identifies primary concern as 'I've been having more anxiety at night in the last year. I work sales, so this is a problem.' Veteran reports that he has been diagnosed with PTSD in the past, and now 'memories of the Tet offensive keep coming back to me'...Veteran reports he has difficulty being in places that are 'too crowded, like Times Square, then I have to leave.' Day to day, he is able to manage crowds. He is uncomfortable flying and avoids it; he did have a panic attack on a plane once before. Endorses mild irritability." See January 2017 VA Mental Health Outpatient Note. "[January 2017 continued] Veteran has noticed attention span decreasing and irritability increasing over the last year, particularly in the evenings. He has started smoking marijuana to help anxiety / irritability, but his isn't helping. He worries about finances and work; he works from home and can't work much recently, since he can't focus. Reports energy is 'not great.' Denies symptoms of depression. Denies suicidal ideation / homicidal ideation. Mental Status...alert and oriented...Mood 'even, balanced' / affect congruent with topic of conversation. Demeanor polite. Eye contact within normal limits. Rate / tone / volume of speech within normal limits. Attention and concentration within normal limits. Thought content and process within normal limits. No evidence of psychosis, preoccupations, or delusions. No psychomotor agitation or retardation noted. Judgment / impulse control appear intact. Insight good. Denies suicidal ideation / homicidal ideation. No evidence of risk of harm to self or others noted or report. Diagnostic Impression: Other specified trauma and stressor related disorder. Disposition...Discussed Mental Health treatment options with Veteran. Provided psychoeducation on cannabis use and that it can intensify symptoms of anxiety in some people." See January 2017 VA Mental Health Outpatient Note. An August 2017 VA treatment note documented: "Chief Complaint: Agitation, insomnia...History of Present Illness...depression...Reports that he continues to be agitated, especially in the afternoons and that his wife has told him he is more 'snappy' than usual. Reports not being able to sleep at night but refusing any recommendations to go speak to Mental Health, work on his sleep hygiene, and PTSD, stating he tried in the past, and they just don't help. States Marijuana helps all of his symptoms and inquiring for the possibility of a prescription. Denies suicidal ideation / homicidal ideation...Social History...Recently started using Marijuana and intends to continue...Physical Examination...General...Cooperative...Psych: Stable, denies suicidal ideation / homicidal ideation...Assessment and Plan...Anxiety and memory Possible due to Marijuana use but more likely depression. Declined MRI last visit, stating, 'Maybe I am feeling lazy and not trying hard enough to remember'...Declined Mental Health visit. Has B12 vitamins at home, agrees to start taking them. Encouraged to speak with someone he feels comfortable with. Increase activities that bring him joy, walk, and stay physically active, avoid arguments, smoking / drinking. Eat a healthy, balanced diet." See August 2017 VA Primary Care Note. VA treatment in March 2018 indicated: "Very pleasant 71-year-old male comes to clinic for regular follow-up visit. Patient denies any changes in his condition since his last visit...Review of Systems...no newly reported depression / anxiety...Social History...Recently stated using Marijuana and intends to continue...Physical Examination...Psych: Stable, denies suicidal ideation / homicidal ideation." See March 2018 VA Primary Care Physician E & M Note; see also March 2018 VA Nursing Emergency Department Note. A January 2019 VA treatment note mentioned: "Very pleasant 72-year-old male...states he has noted increase in anxiety, agitation, disrupted sleep, difficulty concentrating...has been managing with cannabis...seen by mental health in the past but did not follow up...waking up at night 2-3 times, depending on the food intake...Primary symptom is [urinary] urgency...Social History...Recently started using Marijuana and intends to continue...Physical Examination...Psych: Alert and oriented x 4, cooperative, full affect, pleasant, no suicidal / homicidal ideation." See January 2019 VA Primary Care Physician E & M Note. In February 2019, VA mental health treatment noted: "Veteran lives with his wife of 50 years. He has 2 daughters and 4 grandchildren. He has a lot of friends and work colleagues, but he has not started withdrawing socially from them...Veteran words as an executive in a startup cannabis growth company...Mental Status Examination...Hygiene is good...Veteran is polite and cooperative and engaged...No other significant behavior noted...Fully alert and oriented...Memory, concentration, and attention within normal limits...No evidence or endorsement of hallucinations, delusions, or other symptoms of psychosis...No current or recent suicidal or homicidal ideation endorsed." See February 2019 VA Mental Health Consult. June 2019 VA mental health treatment recorded: "Veteran reported that he has been self-medicating, drinking alcohol and smoking marijuana, as his primary means of coping and to help him sleep...He becomes easily agitated over things that are 'not a big deal'...He is anxious...Due to the stress levels he faced from the bankruptcy...he was no longer able to function...Personal Dimensions...has a total of 5 brothers and 2 sisters. He has a good relationship with all of them...Social...He spends time consulting for people, likes reading, and studying the market...Environmental...Veteran lives with: wife...Education: 2 years of college...Legal: Current / pending charges: No. Legal history...No...Mental Status Examination: Orientation: Veteran was oriented x 4. Appearance...well-groomed. Behavior: good eye contact. Psychomotor: within normal limits. Affect: Congruent with content. Speech: normal. Attention: attentive, responsive. Thought Process: rational, organized, goal directed. Thought Content: within normal limits. Judgment: Good. Insight: Good...No evidence of unusual behaviors or psychosis...denied any suicidal and / or homicidal ideation, plan, or intent." See June 2019 VA Mental Health Initial Evaluation Note. A July 2019 VA mental health treatment note reflected: "Patient is a 72-year-old, married, male living with his wife. Currently retired...History of Present Illness...He is currently not taking any medications from Mental Health...He reports that he gets between 4-5 hours of sleep. He wakes up frequently because of having to use the restroom. He naps at times, snores, is overweight, feels tired and fatigued in the AM. Has never had a sleep study...He denied any nightmares...He endorsed anger and irritability but denied any violent episodes. He feels it is very hard for him to focus as far as his memory is concerned...He reports he is not hypervigilant...Denied any feelings of guilt...Emphatically denied any current suicidal or homicidal ideations, thoughts, plans, or intent. Denied any audio / visual hallucinations, symptoms of mania, OCD, gambling disorders, eating disorders, self-harm behaviors." See July 2019 VA Psychiatry Note. "[July 2019 continued] He endorsed anxiety...I urged to use caution, given he is using both alcohol and THC and discussed risk of respiratory depression...Past Psychiatric History: Inpatient: denied. Outpatient: denied. Previous Medications: Xanax for travel. Legal: denied. Rehab: denied. Suicide Attempts: denied...Social / Developmental History...Has 4 brothers and 2 sisters. He is in touch with them...Has been married once for nearly 50 years. Has 2 daughters and 6 granddaughters. Has a few close friends...Mental Status Examination: Patient is alert and oriented x 4, good grooming and hygiene...calm, cooperative, pleasant, maintains good eye contact, no psychomotor agitation or retardation observed...Thought Process / Thought Content: linear, logical, goal-oriented, denied any audio / visual hallucinations, no delusions / illusions noted at this time, denied any current suicidal or homicidal ideations, thoughts, plans, or intent. Cognition grossly intact. Insight / judgment: good." See July 2019 VA Psychiatry Note. An August 2019 mental health note from VA reported: "Veteran is not flagged as high risk for suicide." See August 2019 VA Mental Health No Show Note; see also July 2019 VA Emergency Department Note ("Review of Systems...Psychiatric: Not suicidal / homicidal."). Pursuant to the April 2019 Board remand, the Veteran was provided with another medical examination in December 2019. The examining psychologist reviewed the claims file and evidence of record in preparation for her report. The Veteran was examined in person, and his statements were considered, including a report that he has been married for 50 years and is "very emotionally connected to his family." There was no relevant legal or behavioral history for the Veteran. Symptoms were reported by the Veteran as Depressed mood, Anxiety, Panic attacks that occur weekly or less often, Chronic sleep impairment (although medical records for the Veteran reflected an enlarged prostrate resulting in frequent waking to urinate), Flattened affect, 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. See December 2019 VA Initial PTSD examination report. At the December 2019 examination, the Veteran was observed to be appropriately attired and with personal hygiene. Mental status was alert and cooperative. Thought was logical, goal directed, and he was able to interpret three proverbs presented in an abstract manner. Memory, concentration, impulse control, judgment, and insight were all within normal limits. There was no evidence of delusions or hallucinations, current or past suicidal or homicidal ideation, or previous self-harm. The Veteran was diagnosed with Post-Traumatic Stress Disorder, Chronic. Occupational and social impairment was determined by the examining psychologist as "Occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and / or mood." See December 2019 VA Initial PTSD examination report. The most recent VA medical records show that the Veteran is still seeking treatment for mental health and has no concerns. See April 2020 VA Primary Care Physician E & M Note ("PTSD follows with psychiatry; no acute issues."). Analysis The Board recognizes that the Veteran's mental health condition interferes with his ability to function, but a 100 percent disability rating is "a very high standard." See Golden v. McDonough, No. 19-1528 (Published May 18, 2021). The Veteran has been married to his first wife for 50 years and maintains that his marriage is as "solid as a rock." See June 2016 VA Initial PTSD examination report, August 2017 VA Primary Care Note, February 2019 VA Mental Health Consult, June 2019 VA Mental Health Initial Evaluation Note, July 2019 VA Psychiatry Note, and December 2019 VA Initial PTSD examination report. He is "very emotionally connected to his [children and grandchildren]." See March 2013 VA New Patient Note, June 2016 VA Initial PTSD examination report, February 2019 VA Mental Health Consult, and December 2019 VA Initial PTSD examination report. He is the oldest of his siblings, and they "looked to him for approval and guidance" when their mother died. See June 2019 VA Mental Health Initial Evaluation Note, July 2019 VA Psychiatry Note, and December 2019 VA Initial PTSD examination report. The Veteran "has a lot of friends." See June 2016 VA Initial PTSD examination report, February 2019 VA Mental Health Consult, and July 2019 VA Psychiatry Note. Further, the Veteran does not have the severe symptoms found only in the 100 percent evaluation category, including gross impairment in thought processes or communication, persistent delusions or hallucinations, grossly inappropriate behavior, or persistent danger of hurting self or others. See March 2013 VA New Patient Note, June 2016 VA Initial PTSD examination report, January 2017 VA Mental Health Outpatient Note, August 2017 VA Primary Care Note, March 2018 VA Primary Care Physician E & M Note, March 2018 VA Nursing Emergency Department Note, January 2019 VA Primary Care Physician E & M Note, February 2019 VA Mental Health Consult, June 2019 VA Mental Health Initial Evaluation Note, July 2019 VA Psychiatry Note, July 2019 VA Emergency Department Note, December 2019 VA Initial PTSD examination report, and April 2020 VA Primary Care Physician E & M Note. Conclusion The medical evidence of record does not demonstrate that the Veteran is of such limited occupational and social impairment as to associate his symptoms with the criteria in a 100 percent evaluation. The Board finds that a 70 percent disability rating adequately contemplates the symptoms of the Veteran's acquired psychiatric disorder. In reaching this conclusion, the Board has considered the overall disability picture demonstrated by the record to arrive at the appropriate evaluation in this case. A preponderance of the evidence is against a finding that the Veteran is entitled to an initial rating in excess of 70 percent for an acquired psychiatric disorder under 38 C.F.R. § 4.130, DC 9411, for the relevant appeal period. The June 2016 and December 2019 VA medical examinations are the most probative evidence of record on the question of entitlement to an increased rating. The opinions were based on an extensive review of the available evidence, including lay statements from the Veteran, were supported by a detailed rationale, provided data to support any conclusions, and they provided a clear and reasoned analysis, the source of the most probative value in a medical opinion. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). Therefore, the objective medical findings provided in the Veteran's examination reports have been accorded greater probative weight. See Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993) ("[t]he probative value of medical opinion evidence is based on the medical expert's personal examination of the patient, the physician's knowledge and skill in analyzing the data, and the medical conclusion that the physician reaches... the credibility and weight to be attached to these opinions [are] within the province of the adjudicator."). The medical examinations are consistent with the evidence of record regarding the lack of clinical findings of criteria consistent with total occupational and social impairment. The Board has not overlooked the Veteran's statements regarding the severity of his acquired psychiatric disorder. The Veteran is competent to report on factual matters of which he has firsthand knowledge, e.g., difficulties with sleep, depressed mood, and irritability. See Washington v. Nicholson, 19 Vet. App. 362, 368 (2005). The Veteran has provided lay evidence through VA examinations, in addition to mental health treatment, throughout the course of his appeal with respect to the presence of his symptoms. In summary, a clear preponderance of the evidence of record indicates the Veteran does not meet the relevant diagnostic criteria under 38 C.F.R. § 4.130, DC 9411, for entitlement to a disability rating in excess of 70 percent for an acquired psychiatric disorder during the relevant appeal period. Therefore, his claim for an increased initial evaluation must be denied. In reaching the conclusions stated above, the Board has considered the applicability of the benefit of the doubt doctrine. The rule does not apply when the Board finds that a preponderance of the evidence is against the claim. 38 U.S.C. § 5107; 38 C.F.R. § 3.102 (2018); Ortiz v. Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1990). 2. Entitlement to an effective date prior to Oct 21, 2015, for service connection of an acquired psychiatric disorder, to include PTSD. The Veteran contends that he is entitled to an earlier effective date for his acquired psychiatric disorder. See May 2017 VA Form 21-0958, Notice of Disagreement and January 2018 VA Form 9, Appeal to Board of Veterans' Appeals. Effective Dates of Claims The provisions governing the assignment of the effective date of a claim for compensation or an increased rating are set forth in 38 U.S.C. § 5110(a) and (b), and 38 C.F.R. § 3.400(b) and (o). The general rule regarding effective dates is: "Unless specifically provided otherwise in this chapter, the effective date of an award based on an initial claim, or a supplemental claim, of compensation, dependency and indemnity compensation, or pension, shall be fixed in accordance with the facts found, but shall not be earlier than the date of receipt of application thereunder." See 38 U.S.C. § 5110(a); see also 38 C.F.R. 3.400, General ("Except as otherwise provided, the effective date of an evaluation and award of pension, compensation, or dependency and indemnity compensation based on an initial claim or supplemental claim will be the date of receipt of the claim or the date entitlement arose, whichever is later."). For claims of disability compensation filed under 38 C.F.R. § 3.4(b), which includes "[b]asic entitlement...if the veteran is disabled as the result of a personal injury or disease (including aggravation of a condition existing prior to service) while in active service," the effective date of claims is: "Day following separation from active service or date entitlement arose if claim is received within 1 year after separation from service; otherwise, date of receipt of claim, or date entitlement arose, whichever is later." See 38 C.F.R. 3.400(b)(2)(i) The provisions of 38 C.F.R. § 3.157 commence with a restatement of the general rule that the effective date of pension or compensation benefits will be the date of receipt of the claim or the date when entitlement arose, whichever is later. The regulation further provides: "A report of examination or hospitalization which meets the requirements of this section will be accepted as an informal claim for benefits under an existing law or for benefits under a liberalizing law or Department of Veterans Affairs issue, if the report relates to a disability which may establish entitlement. Acceptance of a report of examination or treatment as a claim for increase or to reopen is subject to the requirements of § 3.114 with respect to action on Department of Veterans Affairs initiative or at the request of the claimant and the payment of retroactive benefits from the date of the report or for a period of 1 year prior to the date of receipt of the report." See 38 C.F.R. § 3.157(a). According to 38 C.F.R. § 3.157(b): "Once a formal claim for pension or compensation has been allowed or a formal claim for compensation disallowed for the reason that the service-connected disability is not compensable in degree, receipt of one of the following will be accepted as an informal claim for increased benefits or an informal claim to reopen...(1) Report of examination or hospitalization by Department of Veterans Affairs or uniformed services. The date of outpatient or hospital examination or date of admission to a VA or uniformed services hospital will be accepted as the date of receipt of a claim...The provisions of this paragraph apply only when such reports relate to examination or treatment of a disability for which service connection has previously been established or when a claim specifying the benefit sought is received within one year from the date of such examination, treatment or hospital admission. (2) Evidence from a private physician or layman. The date of receipt of such evidence will be accepted when the evidence is furnished by or in behalf of the claimant is within the competency of the physician or lay person and shows the reasonable probability of entitlement to benefits. (3) State and other institutions. When submitted by or on behalf of the veteran and entitlement is shown, date of receipt by the Department of Veterans Affairs of examination reports, clinical records, and transcripts of records will be accepted as the date of receipt of a claim if received from State, county, municipal, recognized private institutions, or other Government hospitals." See 38 C.F.R. § 3.157(b). Under 38 C.F.R. § 3.400(o), Increases, the effective date of a claim is the date of receipt of the claim or the date entitlement arose, whichever is later. However, "if a complete claim or intent to file a claim is received within 1 year of such date," the effective date of the claim is the "[e]arliest date as of which it is factually ascertainable based on all evidence of record than an increase in disability had occurred." In addition, "When medical records indicate an increase in a disability, receipt of such medical records may be used to establish effective date(s) for retroactive benefits based on facts found of a disability only if a complete claim or intent to file a claim for an increase is received within 1 year of the dae of the report of examination, hospitalization, or medical treatment." The regulation clarifies that the provisions apply only to reports of examination or treatment of disabilities for which service connection had already established. See 38 C.F.R. § 3.400(o)(1) and (2). Factual Background As mentioned previously, the Veteran separated from active-duty service in October 1968. See October 1968 Form DD214, Certificate of Release or Discharge from Active Duty. The Veteran completed VA Form 21-0966, Intent to File a Claim for Compensation and / or Pension, which was received by VA on October 21, 2015. See October 2015 VA Notification Letter ("We received your intent to file on October 21, 2015. You indicated you would like to file a claim for compensation."). Prior to the submission of the October 2015 Intent to File, the Veteran had no claim history with VA. A VA Form 21-526EZ, Application for Disability Compensation, followed in January 2016. See January 2016 VA Form 21-526EZ, Application for Disability Compensation ("(B) Tinnitus, PTSD"). Service connection for the January 2016 claim was granted in a June 2016 rating decision. See June 2016 VA Rating Decision Narrative ("Service connection for other specified trauma and stressor related disorder is granted with an evaluation of 0 percent effective October 21, 2015."). Analysis Under 38 C.F.R. § 3.400, "the effective date of an evaluation and award of pension, compensation, or dependency and indemnity compensation based on an initial claim or supplemental claim will be the date of receipt of the claim or the date entitlement arose, whichever is later." See 38 C.F.R. § 3.400, "General." To be eligible for an effective date prior to October 21, 2015, the Veteran would have to had submitted a claim for compensation, which he did not do. Because the Veteran did not submit a claim for compensation prior to October 21, 2015, which includes within one year after separation from active duty, the provisions of 38 C.F.R. § 3.400(b)(2)(i), "date of receipt of claim," continues to govern to his effective date for disability benefits. Conclusion In summary, a preponderance of the evidence is against a finding of entitlement to service connection for an acquired psychiatric disorder prior to the October 21, 2015, receipt of claim for disability by VA. At the time of his claim for service connection, the Veteran was not separated from service less than one year. The earliest possible date on which the Veteran's initial grant of service connection could be granted was the October 21, 2015, VA receipt of the Veteran's Intent to File. Therefore, an earlier effective date for the Veteran's acquired psychiatric disorder is not warranted, and the appeal must be denied. As a preponderance of the evidence is against the award of an effective date prior to October 21, 2015, for an acquired psychiatric disorder, to include PTSD, the benefit-of-the-doubt doctrine is not applicable in the instant appeal. See 38 U.S.C. § 5107(b); Ortiz v. Principi, 274 F.3d 1361 (Fed. Cir. 2001); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1991). MARJORIE A. AUER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. Small, Attorney Advisor 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.