Citation Nr: 21070004 Decision Date: 11/22/21 Archive Date: 11/22/21 DOCKET NO. 16-03 880A DATE: November 22, 2021 ORDER Entitlement to an increased disability rating of 50 percent beginning February 28, 2011 to July 26, 2013, for posttraumatic stress disorder (PTSD) with secondary insomnia is granted. Entitlement to a disability rating higher than 50 percent prior to July 26, 2013 for posttraumatic stress disorder (PTSD) with secondary insomnia is denied. Entitlement to an effective date earlier than July 26, 2013, for the grant of a 100 percent disability rating for posttraumatic stress disorder (PTSD) with secondary insomnia is denied. FINDINGS OF FACT 1. Resolving doubt in the Veteran's favor, the Veteran's treatment for PTSD on February 28, 2011 showing an increase in the severity of his PTSD is an informal claim for an increased rating. 2. for the entire period from February 28, 2008, to July 26, 2013, the Veteran's PTSD was manifested by occupational and social impairment with reduced reliability and productivity due to such symptoms as depressed mood, anxiety, chronic sleep impairments, mild memory loss, such as forgetting childhood events, disturbances of motivation and mood, difficulty in adapting to stressful circumstances, including work and social relationships; flashbacks; frequent nightmares; angry outbursts; and hypervigilance. 3. For the period prior to July 26, 2013, the severity, frequency, and duration of the Veteran's symptoms did not more closely approximate occupational and social impairment with deficiencies in most areas. 4. For the period prior to July 26, 2013, it is not factually ascertainable that the Veteran's PTSD met the criteria for a total rating as total occupational and social impairment is not shown. CONCLUSIONS OF LAW 1. The criteria for an increased disability rating of 50 percent, but not higher, from February 28, 2011, to July 26, 2013 for service-connected PTSD are met. 38 U.S.C. §§ 1155, 5107, 7104; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.16, 4.130, DC 9411. 2. The criteria for a disability rating higher than 50 percent, for the period prior to July 26, 2013 for service-connected PTSD are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.126, 4.130, Diagnostic Code 9411. 3. The criteria for an effective date earlier than July 26, 2013, for the assignment of a total rating for PTSD are not met. 38 U.S.C. § 5101, 5107, 5110, 5111; 38 C.F.R. §§ 3.400. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served honorably in the United States Army from August 2001 to June 2008, which service included two tours in Iraq. This matter has a lengthy procedural history that has been outlined in prior Board decisions, the details of which are included herein by reference. Addressing the most recent procedural history, in December 2019, the United States Court of Appeals for Veterans Claims (Court) issued a Joint Motion for Remand (JMR) in response to the Veteran's appeal of the Board's November 2019 denial of the Veteran's claim for an earlier effective date for the grant of 100 percent rating for PTSD. The December 2019 Court order instructed the Board to consider whether medical records from the White City VA medical center (VAMC) constitute informal claims under 38 C.F.R. § 3.157(b)(1) sufficient to warrant an earlier effective date for the grant of a 100 percent rating for PTSD and/or an increased disability rating higher than 30 percent prior to July 26, 2013. In a June 2020 decision, the Board again found that that the preponderance of the evidence shows that the Veteran is not entitled to an effective date earlier than July 26, 2013, for the award of a 100 percent disability rating for PTSD. The Veteran subsequently appealed the June 2020 Board decision to the Court. In a May 2021 JMR, the Court vacated and remanded the June 2020 Board decision noting that the Board erred by failing to comply with the December 2019 JMR. The matter is again before the Board for actions consistent with terms of the Court's December 2019 and May 2021 JMR. 1. Entitlement to an increased disability rating of 50 percent from February 28, 2009 to July 26, 2013 for PTSD 2. Entitlement to a disability rating higher than 50 percent prior to July 26, 2013 The Veteran was previously granted service connection for PTSD with secondary insomnia and assigned a 30 rating effective June 28, 2008. In July 2013, he submitted a claim for an increased rating for this condition and was granted a 100 percent rating effective July 26, 2013 (date of his increased rating claim). The Veteran argues that he is entitled to an earlier effective date prior to July 26, 2013 for the award of 100 percent for PTSD. As noted above, per the terms of the JMRs issued in this case, he Court has requested that the Board consider whether the Veteran's VA medical records constitute informal claims under 38 C.F.R. § 3.157(b)(1) sufficient to warrant an earlier effective date and/or increased ratings prior to July 26, 2013. The Board notes that under 38 C.F.R. § 3.157, a report of examination or hospitalization will be accepted as an informal claim for benefits. Based on review of the record, the Board finds that the Veteran's treatment records from the White City VAMC, can be construed as a petition to file an increased rating claim for the service-connected PTSD. In the instant case, the Board finds that from February 28, 2011, to July 26, 2013, the Veteran's PTSD has been manifested by occupational and social impairment productive of occupational and social impairment with reduced reliability and productivity due to depressed mood, anxiety, chronic sleep impairments, mild memory loss, such as forgetting childhood events, disturbances of motivation and mood, difficulty in adapting to stressful circumstances, including work and social relationships; flashbacks, frequent nightmares, angry outbursts and hypervigilance. Disability evaluations are determined by the application of a schedule of ratings which is based, as far as can practically be determined, on the average impairment of earning capacity. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Each service-connected disability is rated on the basis of specific criteria identified by Diagnostic Codes. 38 C.F.R. § 4.27. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability more closely approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The degrees of disability specified are considered adequate to compensate for a loss of working time proportionate to the severity of the disability. 38 C.F.R. § 4.1. Where the rating appealed is the initial rating assigned with a grant of service connection, the entire appeal period is for consideration, and separate ratings may be assigned for separate periods of time based on facts found, a practice known as "staged ratings." See Fenderson v. West, 12 Vet. App. 119 (1999). In order to evaluate the level of disability and any changes in severity, it is necessary to consider the complete medical history of a veteran's disability. Schafarth v. Derwinski, 1 Vet. App. 589, 594 (1991). After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. 38 U.S.C. § 5107 (b); 38 C.F.R. § 4.3 (2017). The Veteran's post-traumatic stress disorder (PTSD) is rated pursuant to 38 C.F.R. § 4.130, Diagnostic Code 9411. A 30 percent rating is assigned 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). A 50 percent rating contemplates 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; impairments of short-and long-term memory; impaired judgment; impaired abstract thinking; disturbance of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships. A 70 percent evaluation is warranted where there is occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; intermittently illogical, obscure, or irrelevant speech; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work like setting); inability to establish and maintain effective relationships. A 100 percent evaluation is warranted where there is total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); 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. Symptoms listed in VA's general rating formula for mental disorders are not intended to constitute an exhaustive list, but rather are to serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating. Mauerhan v. Principi, 16 Vet. App. 436 (2002). According to the applicable rating criteria, when evaluating a mental disorder, the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the Veteran's capacity for adjustment during periods of remission must be considered. 38 C.F.R. § 4.126 (a). In addition, the evaluation must be based on all the evidence of record that bears on occupational and social impairment rather than solely on the examiner's assessment of the level of disability at the moment of the examination. Id. Further, when evaluating the level of disability from a mental disorder, the extent of social impairment is considered, but the rating cannot be assigned solely the basis of social impairment. 38 C.F.R. § 4.126 (b). In the October 2008 VA Mental Health Notes, the Veteran endorsed continuing to struggle with PTSD symptoms (hypervigilant, paranoia, anxious and depressed) and difficulties sleeping. He reported that he continues to take Trazodone and may be prescribed another medication at his next appointment. In October 2008, the Veteran stated that it has been harder than he thought to cope and does not want to do anything. The Veteran reported that he barely sleeps, and that he sees shadows or movement out of the corner of his eyes. The Veteran stated that his short term is terrible, that he has forgotten much of his childhood and is only able to remember one of three words in 5 minutes. Regarding concentration, the Veteran stated that he cannot read for any great length of time. Mental status examination reveals the Veteran's thought process as sequential and logical. There was no evidence of delusion, suicidal or homicidal ideation. See CAPRI. The Veteran was afforded an initial PTSD examination in February 2009. The Veteran was diagnosed with PTSD. The Veteran reported insomnia and difficulty sleeping. Mental status examination revealed anxious mood, intact attention, unremarkable thought processes, and average intelligence. It was noted that the Veteran has been tried on antidepressants, but they were not very helpful. The Veteran reported that his daily symptoms interfere with his life. There was no reduced reliability and productivity due to PTSD symptoms. No panic attacks, no homicidal/suicidal thoughts were noted. The Veteran reported increased isolation and reduced memory, stating "I zone out sometimes" and it is "hard to stay focused." The Veteran stated that he is unemployed because of his stress disorder as he is irritable and intolerant of being around people. The examiner commented that the Veteran's moderate PTSD symptoms have a significant impairment on his daily functioning. Based on these findings, an April 2009 rating decision granted service connection for PTSD with secondary insomnia with an initial evaluation of 30 percent. The Veteran continued to seek treatment at VA but however, did not file a notice of disagreement with that rating decision. Thus, the April 2009 rating decision became final. However, as stated previously, the Board notes that under 38 C.F.R. § 3.157, a report of examination or hospitalization will be accepted as an informal claim for benefits. Id. In the May 2021 JMR, the parties noted that in its prior decision, while the Board addressed the applicability of 38 C.F.R. § 3.157(b), the Board's finding that the [Veteran's] White City VAMC records did not show a worsening of his PTSD was conclusory and the Board failed to discuss why these records from April 2009 to July 2013 did not show a worsening of his PTSD symptomatology to a claim for an increased rating. In order to address the concerns raised in the JMR the Board has thoroughly reviewed the evidence of record including the White City VAMC records to determine whether these records considered by an informal claim for an increased rating for his PTSD. VA mental health treatment records dated July 7, 2009 and August 10, 2009 note that the Veteran was seen for medication management and supportive psychotherapy. He was not sleeping with any regular pattern. He denied any substance abuse and denied any suicidal ideation. On mental status examination, the Veteran was oriented. His dress and grooming was noted to be appropriate. His speech was of normal rate and rhythm. While he was depressed, his affect was congruent and his thought process was sequential and logical. His judgment and insight were good. These records are not indicative of symptomatology consistent with a rating in excess of 30 percent for PTSD. These records do not show occupation and social impairment with reduced reliability and productivity. During these visits, the Veteran did not have symptoms such a flattened affect. Rather than having circumstantial, circumlocutory, or speech, the Veteran's speech was noted to be normal. These records do not show that he experienced difficulty in understanding complex commands or impairment of short and long term memory. Likewise, neither impaired judgment nor impaired abstract thinking was shown. Further difficulty in establishing and maintaining effective work and social relationship is not shown. As these records do not show an increase in severity consistent with a higher rating, the Board concludes that these records do not constitute a claim for an increased rating under 38 C.F.R. § 3.157. An October 5, 2009 mental health treatment note indicates that the Veteran was seen for medication management and supportive psychotherapy. The Veteran reported that he was doing fairly well in school taking 12 credit hours. His sleep was a bit better. He was off his antidepressant. He was taking thyroid medication that seemed to be helping. This record is not indicative of symptomatology consistent with a rating in excess of 30 percent for PTSD. This record does not show occupation and social impairment with reduced reliability and productivity. This record does not show symptoms such a flattened affect or circumstantial, circumlocutory, or speech. Likewise, the record does not show that he experienced difficulty in understanding complex commands or impairment of short and long term memory. Likewise, neither impaired judgment nor impaired abstract thinking was shown. Further difficulty in establishing and maintaining effective work and social relationship is not shown as the Veteran reported that he was doing fairly well in school. As this record does not show an increase in severity consistent with a higher rating, the Board concludes that this record does not constitute a claim for an increased rating under 38 C.F.R. § 3.157. A December 1, 2009 mental health treatment record notes that the Veteran was going to school and doing well in his classes. He reported feeling more tired, but this could be either due to his depression or thyroid problems. He had not been taking his medication and reported that he would take his medications as ordered realizing that they did help and he was better motivated and had less anger when taking his medication as ordered. On mental status examination, the Veteran was oriented. His dress and grooming was noted to be appropriate. His speech was of normal rate and rhythm. While he was depressed, his affect was congruent and his thought process was sequential and logical. His judgment and insight were good. This record is not indicative of symptomatology consistent with a rating in excess of 30 percent for PTSD. This record does not show occupation and social impairment with reduced reliability and productivity. This record does not show symptoms such a flattened affect or circumstantial, circumlocutory, or speech. Likewise, the record does not show that he experienced difficulty in understanding complex commands or impairment of short and long term memory. Likewise, neither impaired judgment nor impaired abstract thinking was shown. Further difficulty in establishing and maintaining effective work and social relationship is not shown as the Veteran reported that he was doing fairly well in school. As this record does not show an increase in severity consistent with a higher rating, the Board concludes that this record does not constitute a claim for an increased rating under 38 C.F.R. § 3.157. A December 21, 2010 VA outpatient treatment record notes that the Veteran was seen with a complaint of ear pain. At the time of the visit, the Veteran was noted to be hyperverbal and oriented times three. The treating provider noted that the Veteran was pleasant. He had not seen a mental health provider over a year. He reported that he slept more lately and wanted to isolate. He felt that "things have kind of been going downhill" and he wanted to "get back to normal." He was going to school and lived with girlfriend who was pregnant with his first child. The Veteran reported that he was depressed, but not suicidal. A PTSD screen was positive. Depression screen revealed that he had little interest or pleasure in doing things more than half the days and felt down, depressed, or hopeless more than half the days. This record is not indicative of symptomatology consistent with a rating in excess of 30 percent for PTSD. This record does not show occupation and social impairment with reduced reliability and productivity. This record does not show symptoms such a flattened affect or circumstantial, circumlocutory, or speech. Likewise, the record does not show that he experienced difficulty in understanding complex commands or impairment of short and long term memory. Likewise, neither impaired judgment nor impaired abstract thinking was shown. While the Veteran reported that he wanted to isolate himself, difficulty in establishing and maintaining effective work and social relationship is not shown as the Veteran reported that he was still attending school and residing with his girlfriend. As this record does not show an increase in severity consistent with a higher rating, the Board concludes that this record does not constitute a claim for an increased rating under 38 C.F.R. § 3.157. A January 2011 nurse practitioner note indicates that the Veteran felt a "bit fatigued" but felt "tons" better after starting levothyroxine for his hypothyroidism. Notably, review of the Veteran's mental health was negative and he no thoughts of self-harm or harm to others. This record is not indicative of symptomatology consistent with a rating in excess of 30 percent for PTSD. This record does not show occupation and social impairment with reduced reliability and productivity. This record does not show symptoms such a flattened affect or circumstantial, circumlocutory, or speech. Likewise, the record does not show that he experienced difficulty in understanding complex commands or impairment of short and long term memory. Likewise, neither impaired judgment nor impaired abstract thinking was shown. Further difficulty in establishing and maintaining effective work and social relationship is not shown. As this record does not show an increase in severity consistent with a higher rating, the Board concludes that this record does not constitute a claim for an increased rating under 38 C.F.R. § 3.157. VA mental health treatment records dated February 28, 2011 and May 17, 2011 note that the Veteran was seen for supportive psychotherapy. He reported problems with concentration and sleep. He was going to school regularly and working on taking nursing classes. His was prescribed for Prozac in February that was increased in May to see if that would help his problems with concentration. On examination, the Veteran was alert and attentive. His appeared agitated and his grooming was appropriate. His speech showed a normal rate and rhythm and his language was intact. He had an anxious mood with no perceptual disturbance. His thought process and association were normal and coherent and he had no usual thought context. His insight and judgment were noted to be good and his memory was intact. In contrast to the earlier VAMC treatment records, these treatment records show an increase in the Veteran's symptomology necessitating the prescription of Prozac and a subsequent increase in his medication to treat problems concentrating. Likewise, his mood was described as anxious. Given this increase in symptomatology and affording, the Veteran the benefit of the doubt the Board concludes that the February 28, 2011 treatment record shows a worsening of symptoms over previous VA treatment records. In a July 2011 treatment note from the White City VAMC the Veteran reported that he was still having problems with concentration and memory and that he seems to wake up around 2 pm, no matter what time he goes to bed. He also reported that he is taking four summer classes and has difficulty concentrating on his schoolwork. On the mental status exam, orientation and consciousness was noted as alert and attentive. The Veteran was said to be fully oriented. His appearance and behavior were noted as agitated, grooming was appropriate, and speech was normal in rate and rhythm. Language was said to be intact; affect was congruent with mood. There were no homicidal or suicidal ideations. Judgement was good and memory was intact. See CAPRI. In a January 2012 VA treatment note, the Veteran reported having problems with his depression stating, "lately my energy has been going in the crappers again." The Veteran stated that he broke up with his girlfriend and lives with his mother. It was noted that the Veteran was on Prozac. The psychological examination noted the following: "Oriented x3, pleasant, answers questions appropriately, speech is not pressured and is normal in volume, maintains good eye contact in the visit, affect is appropriate to the situation." Suicide/homicidal risk was noted as negative. See CAPRI. The Veteran was afforded a VA examination in March 2014. The Veteran reported that he is socially reclusive and does not see his family very frequently. The Veteran indicated that he went to college from Fall 2009 until Winter 2013 but had some difficulty with concentration. The VA examiner noted depressed mood, anxiety, suspiciousness, panic attacks, chronic sleep impairment, mild memory loss, disturbances of motivation and mood, difficulty establishing and maintaining effective work and social relationships, difficulty adapting to stressful circumstances, suicidal ideation, impaired impulse control, persistent delusions or hallucinations, neglect of personal appearance and hygiene, and disorientation to time or place. See March 2014 C&P Examination. In a February 2016 letter, the Veteran's mother reported that her son's condition has progressively gotten worse since he got out of the military in 2008. See VA Form 9. The Board notes that adjudicator is charged with interpreting the competent and credible evidence of record as a whole and reconciling such to accurately reflect the disability. Moore v. Shinseki, 555 F.3d 1369, 1373 (Fed. Cir. 2009); 38 C.F.R. § 4.2. Affording the Veteran, the benefit of the doubt, the Board finds that he is entitled to a 50 percent rating, but no higher, February 28, 2011 to July 26, 2013. As noted above, treatment records dating from February 28, 2011, show an increase in severity of the Veteran's PTSD. The Board finds the Veteran's lay statements credible as to the symptoms of his PTSD for the period under review. The Board finds that the Veteran's VA examinations and VA treatment records, taken together with the lay statements of record, are indicative of an increase in severity of this Veteran's PTSD symptoms from February 28, 2011 to July 26, 2013. Here, the Board finds that the Veteran symptoms beginning with the February 28, 2011 treatment record more closely approximate occupational and social impairment with reduced reliability and productivity due to symptoms of depressed mood, anxiety, chronic sleep impairments, mild memory loss, such as forgetting events of his childhood, disturbances of motivation and mood, difficulty in adapting to stressful circumstances, including work and social relationships. The Veteran has also endorsed symptoms of flashbacks, frequent nightmares, hypervigilance, and angry outbursts. See CAPRI. The Board finds that a 70 percent rating is not warranted for the appeal period prior to July 26, 2013. The Board observes that the Veteran has consistently denied symptoms of suicidal or homicidal ideations throughout his treatment records. Further, although the Veteran appears to keep to himself, he has maintained a long-term relationship with his mother and sister. Hence, the evidence has not demonstrated an inability to establish and maintain effective relationships. See CAPRI. Additionally, the Board observes that the Veteran denied the presence of panic attacks associated his PTSD. See CAPRI. Therefore, the Board concludes that the Veteran's PTSD symptoms do not reflect the frequency, severity or duration contemplated by the schedular criteria to warrant a 70 percent rating. Overall, the Board finds that his PTSD symptoms do not appear to be so severe as to limit his occupational and social functioning on a daily basis but do reduce his reliability and productivity. Specifically, the Board finds that the evidence of record does not reflect symptomatology of the Veteran's PTSD that would meet or approximate the criteria for a rating of 70 percent or higher prior to July 26, 2013. As referenced above, at no time during the appeal period under review is there evidence of 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 interfered with routine activities, illogical speech, near-continuous panic, or depression affecting the ability to function independently or inability to establish and maintain effective relationships. Therefore, the Board finds the preponderance of the evidence is against a finding that the Veteran's symptoms more nearly approximate the criteria for a 70 percent disability rating for the period prior to July 26, 2013. After careful consideration of the evidence of record, the Board finds that resolving doubt in the Veteran's favor, the February 28, 2011 treatment record is an informal claim for an increased rating and the criteria for entitlement to a 50 percent rating, but no higher, for the service-connected PTSD have been met or approximated from February 28, 2011 to July 26, 2013. As a final point, the Board notes that although the Veteran does not have all of the listed symptoms provided with a 50 percent rating, such as flattened affect; circumstantial, circumlocutory, or stereotyped speech or panic attacks more than once a week, the provided symptoms are not to be treated as a checklist when determining what rating is appropriate. Mauerhan, 16 Vet. App. at 442. Therefore, considering the entire picture of the Veteran's symptoms between February 28, 2011 and July 26, 2013, a rating of 50 percent, but no higher, is warranted. In conclusion, the Board grants the Veteran's claim for a higher disability rating of 50 percent, but no higher, beginning June 28, 2008 to July 26, 2013, and denies a disability rating greater than 50 percent prior to July 26, 2013. 3. Entitlement to an effective date earlier than July 26, 2013, for the grant of a 100 percent disability rating for posttraumatic stress disorder (PTSD) with secondary insomnia The Veteran contends that he is entitled to an effective date prior to July 26, 2013 for the schedular 100 percent rating for PTSD. A March 2014 rating decision granted a 100 percent schedular rating for the Veteran's PTSD, effective from July 26, 2013 (date of increased rating claim). Generally, the effective date is the date of receipt of the claim, or the date entitlement arose, whichever is later, unless otherwise provided. 38 U.S.C. § 5110 (a); 38 C.F.R. § 3.400. Entitlement arises on the date the claimant meets the basic eligibility criteria. For increased rating claims, if the increase occurred within one year prior to the claim, the increase is effective as of the date the increase was "factually ascertainable." 38 C.F.R. § 3.400 (o)(2); Harper v. Brown, 10 Vet. App. 125 (1997); VAOPGCPREC 12-98 (Sept. 23, 1998). If the increase occurred more than a year prior to the claim, the effective date shall be the date of the claim. 38 C.F.R. § 3.400(o)(2); Gaston v. Shinseki, 605 F.3d 979 (Fed. Cir. 2010). Finally, if the increase occurs after the claim is filed, the effective date shall be the date the increase occurred. 38 C.F.R. § 3.400(o)(2); Harper v. Brown, 10 Vet. App. 125, 126-27 (1997). The Veteran was afforded a VA examination in March 2014, which showed that his PTSD symptoms approximated total occupational and social impairment. See March 2014 C&P Examination. As shown in previous Board decisions and incorporated here by reference, the Board has carefully reviewed the record to determine whether it is factually ascertainable prior to July 26, 2013, that the Veteran met the criteria for a 100 percent rating for PTSD under the General Formula. However, the criteria are not more nearly met from any other identifiable date of record during the appeal period to include in the one year prior to date of receipt of the Veteran's claim for increase. VA medical records do not indicate that the Veteran's symptoms rose to a disability level of 100 percent prior to the March 2014 VA examination. Although the evidence demonstrates a significant degree of occupational and social impairment due to PTSD prior to July 26, 2013, it does not show total occupational and total 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, disorientation to time or place, or memory loss for names of close relatives, own occupation, or own name. Moreover, there is no evidence that the Veteran does not know his name, occupation, or close relatives. Given the above, the Board finds that there is no basis for the assignment of an effective date earlier than July 26, 2013 for the grant of a 100 percent rating for PTSD; it is not factually ascertainable prior to this date that the Veteran met the schedular criteria for a 100 percent rating. Accordingly, the claim for an earlier effective date for the grant of a 100 percent rating fr PTSD is denied. There is no doubt to resolve. 38 U.S.C. § 5107(b). DAVID L. WIGHT Veterans Law Judge Board of Veterans' Appeals Attorney for the Board N. M. Rogers, Associate Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.