Citation Nr: 21005979 Decision Date: 02/03/21 Archive Date: 02/03/21 DOCKET NO. 11-25 604 DATE: February 3, 2021 ORDER Entitlement to an initial rating of 70 percent prior to April 15, 2013 for posttraumatic stress disorder (PTSD) is granted. Entitlement to a rating in excess of 70 percent from April 15, 2013 to June 1, 2016 PTSD is denied. REMANDED Entitlement to service connection for a lung or respiratory disorder is remanded. FINDING OF FACT For the entire appeal period prior to June 1, 2016, the Veteran’s PTSD more closely approximated occupational and social impairment with deficiencies in most areas without total occupational and social impairment. CONCLUSIONS OF LAW 1. The criteria for an initial rating of 70 percent prior to April 15, 2013 for PTSD have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1—4.14, 4.125, 4.126, 4.130, Diagnostic Code 9411. 2. Prior to June 1, 2016, the criteria for a rating in excess of 70 percent for PTSD have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1—4.14, 4.125, 4.126, 4.130, Diagnostic Code 9411. REASONS AND BASES FOR FINDING AND CONCLUSIONS The Veteran served on active duty in the United States Marine Corps (USMC) from February 1965 to February 1969, to include service in the Republic of Vietnam. The Veteran’s awards and decorations for his service include a Combat Action Ribbon and a Vietnam Cross of Gallantry, among many others. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from September 2009 and January 2011 rating decisions issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Muskogee, Oklahoma. This case was most recently before the Board in November 2018, at which time the appeal was remanded to the Agency of Original Jurisdiction (AOJ) for further development, namely the issuance of a Supplemental Statement of the Case (SSOC). Such an SSOC was issued in August 2020. Therefore, the Board determines that there has been substantial compliance with its previous remand. Stegall v. West, 11 Vet. App. 268 (1998). The case has now been returned to the Board for appellate action. In November 2015, the Veteran testified before a Veterans Law Judge. A copy of the transcript has been associated with the claims file. This hearing was before a now-retired judge. In November 2018 correspondence, the Veteran was given the opportunity to request another hearing and was notified that if he did not provide a response in 30 days, it would be assumed that he did not want another hearing. The Veteran responded to that letter stating he did not request another Board hearing, and the Board will therefore proceed. Increased Rating – PTSD The Veteran generally asserts that he is entitled to higher ratings for his PTSD because his symptoms are more severe than contemplated by the currently assigned ratings. Specific argument in support of this appeal has not been provided. Disability evaluations are determined by evaluating the extent to which a Veteran’s service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, including employment, by comparing his symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.10. 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 evaluation. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Reasonable doubt as to the degree of disability will be resolved in the Veteran’s favor. 38 C.F.R. § 4.3. It is permissible to switch diagnostic codes to reflect more accurately a claimant’s current symptoms. See Read v. Shinseki, 651 F. 3d 1296, 1302 (Fed. Cir. 2011). Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary concern. Although a rating specialist is directed to review the recorded history of a disability in order to make a more accurate evaluation, see 38 C.F.R. § 4.2, the regulations do not give past medical reports precedence over current findings. Francisco v. Brown, 7 Vet. App. 55 (1994). However, the Board must also consider staged ratings. Hart v. Mansfield, 21 Vet. App. 505, 509–10 (2007). Pertinent regulations do not require that all cases show all findings specified by the Rating Schedule, but that findings sufficiently characteristic to identify the disease and the resulting disability and above all, coordination of rating with impairment of function will be expected in all cases. 38 C.F.R. § 4.21. Therefore, the Board has considered the potential application of various other provisions of the regulations governing VA benefits, whether or not they were raised by the Veteran, as well as the entire history of the Veteran’s disability in reaching its decision. Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991). In general, all disabilities, including those arising from a single disease entity, are rated separately, and all disability ratings are then combined in accordance with 38 C.F.R. § 4.25. Pyramiding, the evaluation of the same disability, or the same manifestation of a disability, under different diagnostic codes, is to be avoided when rating a Veteran’s service-connected disability. 38 C.F.R. § 4.14. It is possible for a Veteran to have separate and distinct manifestations from the same injury which would permit rating under several diagnostic codes, however, the critical element in permitting the assignment of several ratings under various diagnostic codes is that none of the symptomatology for any one of the conditions is duplicative or overlapping with the symptomatology of the other condition. See Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994). The basis of disability evaluation is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life including employment. 38 C.F.R. § 4.10. The Veteran is competent to report symptoms and experiences observable by his senses. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); 38 C.F.R. § 3.159(a). Although the Board has an obligation to provide reasons and bases supporting its decision, there is no obligation to discuss, in detail, the extensive evidence of record. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000) (holding that the Board 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 analysis will focus specifically on what the evidence shows, or fails to show, as it relates to the Veteran’s claim. The Veteran is currently rated at 50 percent prior to April 15, 2013 and 70 percent from April 15, 2013 to June 1, 2016 for his PTSD. His PTSD is rated as 100 percent disabling as of June 1, 2016; this is the schedular maximum rating. Psychiatric disabilities are rated based on the General Rating Formula codified in 38 C.F.R. § 4.130, which provides disability ratings are based on a spectrum of symptoms. “A veteran may qualify for a given disability rating by demonstrating the particular symptoms associated with that percentage, or others of a similar severity, frequency, and duration.” Vazquez-Claudio v. Shinseki, 713 F.3d 112, 117 (Fed. Cir. 2013). VA must consider all symptoms of a claimant’s condition that affect the level of occupational and social impairment, including, if applicable, those identified in the American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders (4th ed. 1994) (DSM-IV) and (5th ed. 2013) (DSM-5). See Mauerhan v. Principi, 16 Vet. App. 436, 442–43 (2002). VA is to engage in a holistic analysis in which it assesses the severity, frequency, and duration of the signs and symptoms of the veteran’s service-connected mental disorder; quantifies the level of occupational and social impairment caused by those signs and symptoms; and assigns an evaluation that most nearly approximates that level of occupational and social impairment. Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017). Under the General Rating Formula for Mental Disorders per 38 C.F.R. § 4.130, a 50 percent rating is warranted if the disability is productive of 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 Code 9411. 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. Id. 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 inability to perform activities of daily living (including maintenance of minimal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. Id. In addition, when evaluating a mental disorder, the rating agency shall consider the frequency, severity, and duration of psychiatric symptoms, the lengths of remissions, and the Veteran’s capacity for adjustment during periods of remission. 38 C.F.R. § 4.126(a). The rating agency shall assign an evaluation based on all 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. However, when evaluating the level of disability from a mental disorder, the rating agency will consider the extent of social impairment, but shall not assign an evaluation on the basis of social impairment. The Board notes that with regard to the use of the phrase “such as” in 38 C.F.R. § 4.130 (General Rating Formula for Mental Disorders), ratings are assigned according to the manifestations of particular symptoms. However, the use of the phrase “such as” in 38 C.F.R. § 4.130 demonstrates that the symptoms after that phrase are not intended to constitute an exhaustive list, but rather are to serve only 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). Accordingly, the evidence considered in determining the level of impairment under 38 C.F.R. § 4.130 is not restricted to the symptoms provided in the Diagnostic Code. Instead, VA must consider all symptoms of a claimant’s condition that affect the level of occupational and social impairment. The Board acknowledges that psychiatric examinations frequently include assignment of a global assessment of functioning (GAF) score. The American Psychiatric Association has released the Diagnostic and Statistical Manual of Mental Disorders (5th Ed.) (DSM-5), and 38 C.F.R. § 4.130 has been revised to refer to the DSM-5. The DSM-5 does not contain information regarding GAF scores. Effective August 4, 2014, VA amended the portion of its Schedule for Rating Disabilities dealing with mental disorders to remove outdated references to the DSM-IV and replace them with references to the DSM-5. See 79 Fed. Reg. 45,093, 45,094 (Aug. 4, 2014). VA adopted as final, without change, the interim final rule and clarified that the provisions of the final rule did not apply to claims that were pending before the Board, this Court, or the U.S. Court of Appeals for the Federal Circuit on August 4, 2014, even if such claims were subsequently remanded to the agency of original jurisdiction. See 80 Fed. Reg. 14,308 (Mar. 19, 2015). In Golden v. Shulkin, 29 Vet. App. 221 (2018), the Court held that given that the DSM-5 abandoned the GAF scale and that VA has formally adopted the DSM-5, the Board errs when it uses GAF scores to assign a psychiatric rating in cases where the DSM-5 applies. This appeal was certified to the Board in August 2018. As such, the DSM-5 applies, and the GAF scores will not be considered. A review of the record reveals that the Veteran has sought mental health treatment from VA and private facilities, as well as treatment for his other health needs. To the extent that the Veteran’s treatment records contain information relevant to the severity of his mental health, to include mental health screenings, the Board will summarize this evidence. Turning to the evidence, of record is a December 2009 VA treatment record indicating the Veteran was not very happy as a result of his wife’s chronic illness and that he missed a PTSD treatment appointment due to her hospitalization. A March 2010 VA treatment record indicates the Veteran was seen for treatment for his PTSD and he reported he was currently dealing with difficult financial times. It was noted that “despite his stress he has remained in a good mood with a realistic outlook not overly gloomy.” An August 2010 statement was submitted by the Veteran’s son. In that statement, the Veteran’s son reported the Veteran’s psychiatric symptoms included screaming and yelling in his sleep, being “high strung,” having angry outbursts, being distrustful nature, being in fights with other men, that he did not have friends, nor wanted any friends, that he killed their pet dog, that he always carried a firearm, and that he was forgetful. The statement further noted that the Veteran repeated himself, was easily irritated, made suicidal or homicidal comments, was hypervigilant and nervousness in public. The Veteran’s son reported that when he lived with the Veteran, he felt as he had to “walk on pins and needles around him” and being scared that the Veteran would “blow up.” Further, he reported he was scared the Veteran would kill himself or his wife based on comments that the Veteran made. His son further noted that he would not allow his son to be alone with the Veteran for fear of the Veteran’s conduct. In the Veteran’s August 2010 notice of disagreement, the Veteran reported that hs psychiatric symptoms included chronic sleep impairment and hypervigilance, manifested by always carrying a firearm. An August 2010 statement was submitted by the Veteran’s wife. In that statement, she reported that the Veteran’s psychiatric symptoms included screaming and crying out in his sleep, knocking and kicking her out of the bed onto the floor during sleep, sleeping with a gun, seeing people in Vietnam during sleep, being short-tempered, being angry all the time, losing friends, strained relationships with family, isolation and preferring to not have people over the house, inability to get along with others, unhappiness and depression. She reported she feared being shot by the Veteran when returning home on occasion. An August 2010 statement was submitted by the Veteran’s daughter. In that statement, she reported that the Veteran’s psychiatric symptoms included being moody and experiencing having depression, anxiety and sadness. She also reported that the Veteran was withdrawn from others, slept with a gun within reach, had nightmares, had mixed emotions and had flashbacks. The Veteran was afforded a VA examination in September 2010. At that time, he reported that he got along well with his wife and children, that his only friend died four years prior, and he spent time with his son. He reported hobbies included hunting, previously showing classic cars, and watching television. Upon mental status examination, the Veteran presented as clean, neatly groomed, appropriately and casually dressed, unremarkable psychomotor activity, unremarkable speech and that he was cooperative, friendly and attentive. The examiner found normal affect and that the Veteran was hopeless, agitated, expansive, fearful, easily distracted and had a short attention span. The examiner further found that the Veteran was oriented to all spheres, that he had an unremarkable thought process and content, that he had persecutory delusions persistent; intact judgment, that he had average intelligence and that he had insight that he had a problem. The Veteran reported chronic sleep difficulties that included trouble falling and staying asleep, getting three to four hours total of sleep and napping during the day. He was not shown to have hallucinations. He did not have inappropriate behavior. He reported one to two panic attacks a week. There were homicidal thoughts, and the Veteran had planned to kill somebody but did not carry through the plans. There were suicidal thoughts without intention. The examiner found the Veteran had fair impulse control without episodes of violence. He was able to maintain minimum personal hygiene. Problems with activities of daily living were evaluated as slight household chores, moderate shopping, slight engaging in sports or exercise, slight driving and other recreational activities. The Veteran had mildly impaired remote and immediate memory, and had normal recent memory. The September 2010 VA examiner found that the Veteran’s PTSD symptoms included recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions, recurrent distressing dreams of the event and intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic even. The examiner also found that the Veteran had physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event, efforts to avoid thoughts, feelings, or conversations associated with the trauma and efforts to avoid activities, places, or people that arouse recollections of the trauma. The examiner further found markedly diminished interest or participation in significant activities, feelings of detachment or estrangement from others, restricted range of affect, difficulty falling or staying asleep, irritability or outbursts of anger, difficulty concentrating, hypervigilance and an exaggerated startle response. The examiner noted that the disturbance caused clinically significant distress or impairment in social, occupational or other important areas of functioning. The Veteran had nightmares two to three times per week, was uncomfortable in crowds, and was unable to form or maintain friendships. He reported that he had he would sometimes have good times that lasted a few days, and during those times he would laugh or grin. He reported he could no longer tolerate friendships or crowds, was less loving and caring that he used to be, and got upset with people he worked with when he was working. A December 2011 VA treatment record that indicates the Veteran was doing “well overall,” and that he denied any suicidal ideations or intent. He did not have signs of psychosis. The Veteran admitted to being “down,” and having bad days, but he was assessed as stable and realistic overall. An April 2012 VA treatment record that indicates the Veteran reported depression, being easily frustrated, having no positive outlook on life, wanting to isolate, no longer having hobbies, anxiety and suicidal ideation, but that his wife and family are reasons to keep going. Other reported symptoms included difficulty distinguishing between dreams and wakefulness, violent dreams, being moody and being easily angered. He reported he generally got eight hours of sleep, but had difficulty maintaining sleep on occasion and that he had vivid dreams and nightmares for years. He reported some forgetfulness, and that he had no real social involvement outside of his home. His wife reported that he had a diminished appetite and noticeable cognitive decline that he had a reduced interest in grooming, showering, and attending to hygiene and increased irritability. She reported she put the guns in the home away due to fear of the Veteran’s irritability and sleep disturbances. A May 2012 statement was submitted by the Veteran’s daughter-in-law. In that statement, she reported she lived with the Veteran and that the Veteran’s psychiatric symptoms included chronic sleep impairment, to include being up at all hours of the night and not sleeping a full night, nervousness and constant emotional mood swings. She reported she did not leave her 12-year-old son alone with the Veteran due to fear of the Veteran’s mood swings. A May 2012 statement was submitted by the Veteran’s son. In that statement, the Veteran reported that his psychiatric symptoms included inability to get along with others, memory loss, problems doing daily tasks, moodiness, depression, being suicidal, always having a gun and no longer having hobbies. The Veteran’s son stated that on one occasion, the Veteran was sitting on the porch with a gun and scared his mother. Of record is an October 2013 VA treatment record that indicates worsening of the Veteran’s PTSD symptoms due to worrying about his heart issues. The Veteran was afforded a VA examination in January 2014. At that time, the examiner opined the Veteran’s PTSD manifested in occupational and social impairment with deficiencies in most areas, such as work, school, family relationships, judgment, thinking and/or mood. The Veteran reported he had been married for 46 years, and presented to the interview with his wife. He reported he had no friends and had problems getting along with others; and was retired. He reported being irritable and getting along with others when he did work. Symptoms attributable to his PTSD included depressed mood, anxiety, suspiciousness, chronic sleep impairment, mild memory loss, such as forgetting names, directions or recent events, flattened affect, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, difficulty in adapting to stressful circumstances, including work or a worklike setting, suicidal ideation and neglect of personal appearance and hygiene. Behavioral observations showed the Veteran was cooperative, polite, no evidence of confusion, highly dependent on his wife, and that she was the main source of his support, blunted affect and had PTSD symptoms of sleep problems, anxiety, and irritability around others. He was realistically concerned about his health and was unable to physically take care of his activities of daily living. A March 2014 VA treatment record indicates the Veteran reported his PTSD symptoms were “managed”; had chronic depression, had a negative view of the world, but kept trying, believed he was too old to change, admitted historical suicidal ideation and hopelessness. He reported that he was suicidal, and his son came over and talked with him, and helped him throughout that incident. He expressed some hope with regard to his relationships with his children, grandchildren, and great grandchildren. A June 2014 VA treatment record that indicates the Veteran was sleep well with medication, had stable weight and appetite, good energy, denied anhedonia and good motivation. He reported he was active with his family, but limited contact with others. He had good energy. A November 2012 VA treatment record that was resubmitted by the Veteran in July 2014, with annotations. The Veteran indicated, through his annotations, that he had suicidal ideation, little interest or pleasure in doing things, feeling down, depressed, or hopeless, trouble falling or staying asleep, or sleeping too much, feeling tired or having little energy, poor appetite or overeating, feeling bad about himself, trouble concentrating, moving or speaking so slowly that other people could have noticed and difficulty with work and getting along with others. A July 2014 resubmission of the January 2014 VA examination was made by the Veteran, with annotations. In pertinent part, the Veteran indicated, through his annotations, that additional PTSD symptoms included panic attacks more than once a week, near continuous depression, impairment of short- and long-term memory, forgetting to complete tasks, difficulty in understanding complex commands, impaired impulse control, such as unprovoked irritability with periods of violence, spatial disorientation, persistent danger of hurting others and intermittent ability to perform activities of daily living, including maintenance of minimal personal hygiene. A May 2016 VA treatment record that indicates the Veteran denied suicidal and homicidal ideation, was always depressed at time, and refused to speak to the mental health provider at that time. Further review of the record shows that the Veteran receives VA treatment and from private treatment providers for various disabilities. However, there is no indication from the treatment notes of record that the Veteran has reported mental health symptoms that are worse than those noted above. Based on the foregoing, the Board finds that an initial rating of 70 percent, prior to April 25, 2013, for PTSD is warranted. In this regard, the Board finds that such disability was manifested by occupational and social impairment with deficiencies in most areas, but without total occupational and social impairment. Impairment to mood was demonstrated as the Veteran reported consistent anxiety, irritability, depression, hypervigilance, suspiciousness and social isolation outside of his family members. Some impairment to family relations was shown as the Veteran’s wife described the Veteran had uncontrolled behavior and aggression, scared her on occasion with threatening behavior, and mood swings. Further, impairment to family relations was shown by the Veteran’s son and daughter-in-law’s reports of not allowing their son to be alone with the Veteran due to his mood swings and emotional lability and the Veteran’s son reported he felt as though he had to walk on “pins and needles” around his father. Further, the Veteran himself reported that he had social impairment to family relations because he expressed that he wanted a better relationship with his children, grandchildren, and great grandchildren. However, the Veteran otherwise reported maintaining a generally good relationship with his wife and children. In this regard, his wife was consistently shown to be a good support for him. No impairment to thinking was demonstrated. Specifically, the Board notes that the Veteran has consistently presented as adequately groomed, normal speech and logical thinking. Further, at no time prior to June 1, 2016 has the Veteran’s thought processes been found to be impaired, and his thought content was not found to include delusions. Some impairment to work due to his PTSD was also demonstrated. In this regard, the Veteran was no longer work, but he reported that he had irritability with coworkers and the public when he did work; and that eventually he was no longer able to sustain employment. Judgment was not impaired as it was consistently found to be intact or good during the appeal period. School was not attempted during the appeal period. Therefore, deficiencies in most areas was shown, and his PTSD more closely approximated occupational and social impairment with deficiencies in most areas prior to June 1, 2016. Moreover, the record reflects that the Veteran’s symptoms have not been consistent with total occupational and social impairment such that a 100 percent rating is warranted at any point prior to June 1, 2016. In that regard, the Veteran has not displayed gross impairment in thought processes or communication, nor has the record shown that he is a persistent danger of hurting himself or others or grossly inappropriate behavior. The Veteran has reported some suicidal ideation, plan, or intent; and alleged he had some homicidal ideations. However, homicidal or suicidal attempts were never attempted or started and the Veteran noted that on one occasion, his son helped him move past a period of suicidal ideation. Moreover, there is no evidence that the Veteran has experienced hallucinations or delusions, or obsessive rituals. Further, the Veteran has not displayed disorientation to time or place, or memory loss for names of close relatives, his prior occupations, or his own name. Additionally, there is no evidence or allegation that he was unable to maintain minimal personal hygiene. Mental status examinations during the appeal period consistently found the Veteran’s grooming and hygiene to be appropriate, adequate or good. The Board notes that a January 2014 VA examination indicates the Veteran reported some difficulty with activities of daily living due to his physical disabilities. However, there is no evidence or allegation that the Veteran’s psychiatric symptoms manifested in interference or difficulties resulted in the inability to perform activities of daily life, to include maintenance of minimal hygiene. Moreover, this is not a disability picture indicating total occupational and social impairment at any time during the appeal period. In assessing the severity of his PTSD, the Board has considered the competent lay assertions regarding symptoms experienced and observed. See, e.g., Layno v. Brown, 6 Vet. App. 465, 470 (1994) and Grottveit v. Brown, 5 Vet. App. 91, 93 (1993). However, the criteria needed to support higher ratings as the required medical findings that are within the province of trained medical professionals. See Jones v. Brown, 7 Vet. App. 134, 137-138 (1994). As such, the lay assertions are not considered more persuasive than the objective medical findings which, as indicated above, do not support assignment of any higher rating pursuant to any applicable criteria at any point pertinent to this appeal. The Board notes the contentions of the Veteran and his representative that the Veteran’s PTSD is more severe than currently shown on examination; and the Board observes that the Veteran, while competent to report his observable symptoms, he is not competent to report that his mental health symptoms are of sufficient severity to warrant a higher rating under VA’s tables for rating such disabilities because such an opinion requires medical expertise which he has not been shown to have. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006); Charles v. Principi, 16 Vet. App. 370 (2002). Despite the foregoing, the Board acknowledges the Veteran’s reports of additional PTSD symptoms, to include suicidal ideation, being a persistent danger to others, and near-continuous depression. However, even after considering such contentions as to the effects of the disability on his daily life, the Board finds that the criteria for a higher rating are not met. See Lendenmann, supra. The Rating Schedule contemplates such impairment under the ordinary conditions of daily life. 38 C.F.R. § 4.10; see also Martinak v. Nicholson, 21 Vet. App. 447, 455 (2007). This argument is therefore without merit. The Board has considered whether a staged rating under Hart, supra is appropriate; however, the Board finds that his symptomatology has been stable throughout each period on appeal. Therefore, assigning further staged ratings is not warranted. The Veteran and/or his representative has not raised any other issues, nor have any other issues been reasonably raised by the record in regard to the increased rating claim adjudicated herein. Doucette v. Shulkin, 28 Vet. App. 366 (2017). Finally, the Board is cognizant of the ruling of the Court in Rice v. Shinseki, 22 Vet. App. 447 (2009). In Rice, the Court held that a claim for a total rating based on unemployability due to service-connected disability (TDIU), either expressly raised by the Veteran or reasonably raised by the record, involves an attempt to obtain an appropriate rating for a disability and is part of the claim for an increased rating. In this case, the Veteran reported that he retired as a plumber at age 62 because he was eligible for social security benefits, the construction business had slowed down and that he was having difficulty getting along with others. Moreover, the Veteran explicitly withdrew his claim for a TDIU in January 2018. As such, Rice is inapplicable in this case. Accordingly, the Board finds that a 70 percent rating, but no higher, for PTSD prior to April 25, 2013 is warranted. However, the preponderance of the evidence is against the assignment of a rating in excess of 70 percent for PTSD. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, supra. REASONS FOR REMAND Service Connection – Lung or Respiratory Disorder The Board notes that the Veteran was afforded a VA evaluation for his claimed lung or respiratory disorder in May 2016 and March 2018. At those times, the examiner opined the Veteran’s claimed lung or respiratory disorder was less likely than not as a result of his active service. In that regard, the May 2016 examiner found the Veteran did not have a current diagnosis; and noted that the Veteran had untreated tuberculosis (TB), and that it was unsafe to test the Veteran at that time. The September 2017 Board remand for this opinion to be inadequate to decide the claim. The March 2018 VA examiner found that the Veteran had a diagnosis of restrictive lung disease, and opined that it was less likely than not as a result of active service as the Veteran reported the onset of the condition in 2012 and that a nexus had not been established. In that regard, the March 2018 VA examiner noted that the Veteran was a lifelong smoker, exposed to second-hand smoke as a child, had sleep apnea, and had no indications from imaging studies of asbestos exposure. Moreover, the examiner noted that the Veteran had pulmonary edema following a heart attack in 2012. The Board finds the March 2018 VA examination inadequate to decide the claim. In that regard, the March 2018 VA opinion did not give appropriate consideration to the Veteran’s statements regarding the onset and continuity of his symptoms nor did the opinion adequately provide supporting rationale for the conclusions reached. Further, the March 2018 opinion discussed the Veteran’s contentions that his lung or respiratory disorder was caused by, or chronically worsened by, his service-connected heart disorder. See May 2016 VA Form 9. Accordingly, the Board concludes that the Veteran should be afforded a new VA examination to determine the nature and etiology of his claimed lung or respiratory disorder. The matters are REMANDED for the following action: 1. The Veteran should be given the opportunity to identify any outstanding private or VA treatment records relevant to the claim on appeal. After obtaining any necessary authorization from the Veteran, all outstanding records should be obtained, to include updated VA treatment records. For private treatment records, make at least two (2) attempts to obtain records from any identified sources. If any such records are unavailable, inform the Veteran and his representative and afford him an opportunity to submit any copies in their possession. For federal records, all reasonable attempts should be made to obtain such records. If any records cannot be obtained after reasonable efforts have been made, issue a formal determination that such records do not exist or that further efforts to obtain such records would be futile, which should be documented in the claims file. The Veteran must be notified of the attempts made and why further attempts would be futile, and allowed the opportunity to provide such records, as provided in 38 U.S.C. § 5103A(b)(2) and 38 C.F.R. § 3.159(e). 2. Following the receipt of outstanding records, the Veteran should be afforded an appropriate VA examination to determine the etiology of his claimed lung or respiratory disorder. The record, to include a copy of this Remand, must be made available to and be reviewed by the examiner. Any indicated evaluations, studies and tests should be conducted. The need for further examination is left to the discretion of the examiner. Thereafter, the examiner is asked to furnish an opinion with respect to the following questions: (A) Is at least as likely as not (50 percent or greater probability) that the Veteran’s lung or respiratory disorder had its onset during any period of service, or is otherwise related to such period of service, to include any exposure to asbestos and/or herbicides during active service? The examiner should discuss the significance, if any, of the Veteran’s claimed asbestos exposure during active service. (B) Is at least as likely as not (50 percent or greater probability) that the Veteran’s lung or respiratory disorder was caused or aggravated by his service-connected hypertensive heart disease and coronary artery disease? The examiner should discuss the significance, if any, of the Veteran’s heart surgeries, to include stent placement and bypass surgery. In offering such opinions, the examiner should consider the Veteran’s statements, the lay statement submitted. The examiner must provide a complete rationale for all opinions and conclusions reached. KRISTY L. ZADORA Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Mariah N. Sim, 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.