Citation Nr: 21006333 Decision Date: 02/03/21 Archive Date: 02/03/21 DOCKET NO. 07-09 614 DATE: February 3, 2021 ORDER Entitlement to a rating in excess of 50 percent prior to December 1, 2009, and in excess of 70 percent thereafter, for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD), major depressive disorder, and alcohol use disorder, is denied. FINDINGS OF FACT 1. Prior to December 1, 2009, the Veteran’s acquired psychiatric disorder, to include PTSD, major depressive disorder, and alcohol use disorder, had been manifested by symptoms which most closely equate to occupational and social impairment with reduced reliability and productivity. 2. Since December 1, 2009, the Veteran’s acquired psychiatric disorder, to include PTSD, major depressive disorder, and alcohol use disorder, has been manifested by symptoms which most closely equate to occupational and social impairment with deficiencies in most areas. CONCLUSIONS OF LAW 1. Prior to December 1, 2009, the criteria for an increased rating in excess of 50 percent for an acquired psychiatric disorder, to include PTSD, major depressive disorder, and alcohol use disorder, have not been met. 38 U.S.C. §§ 1155, 1507; 38 C.F.R. §§ 3.102, 4.7, 4.130; Diagnostic Code (DC) 9411. 2. Since December 1, 2009, the criteria for an increased rating in excess of 70 percent for an acquired psychiatric disorder, to include PTSD, major depressive disorder, and alcohol use disorder, have not been met. 38 U.S.C. §§ 1155, 1507; 38 C.F.R. §§ 3.102, 4.7, 4.130; DC 9411. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Navy from July 1995 to July 2004. This matter was previously denied by the Board of Veterans’ Appeals (Board) in December 2017 and the Veteran timely appealed to the Court of Appeals for Veterans Claims (the Court). In a February 2019 Joint Motion for Partial Remand, the Court remanded the matter for further adjudication after it was determined that the Board provided inadequate reasons and bases for its denial. The Board subsequently remanded the matter in July 2019 to obtain a new VA examination and opinion and to obtain any outstanding medical records. The requested development has been completed, and the appeal has returned to the Board for further appellate consideration. The Board is now satisfied there was substantial compliance with the remand. See Stegall v. West, 11 Vet. App. 268 (1998). Increased Rating Disability evaluations are determined by applying a schedule of ratings which is based on average impairment of earning capacity based on the specific diagnostic codes identifying the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Where there is a question as to which of two separate evaluations shall be applied, the higher evaluation will be assigned if the disability more closely approximates the criteria required for that particular rating. 38 C.F.R. § 4.7. While the Board typically considers only those factors contained wholly in the rating criteria, it is appropriate to consider factors outside the specific rating criteria when appropriate in order to best determine the level of occupational and social impairment. See Mauerhan v. Principi, 16 Vet. App. 436 (2002); Massey v. Brown, 7 Vet. App. 204, 208 (1994). Entitlement to a rating in excess of 50 percent prior to December 1, 2009, and in excess of 70 percent thereafter, for an acquired psychiatric disorder, to include PTSD, major depressive disorder, and alcohol use disorder Prior to December 1, 2009, the Veteran had been in receipt of a 50 percent rating for an acquired psychiatric disorder, to include PTSD, major depressive disorder, and alcohol use disorder, under 38 C.F.R. § 4.130, DC 9411. From December 1, 2009, the Veteran has been in receipt of a 70 percent rating for his psychological disability under 38 C.F.R. § 4.130, DC 9411. He contends that his symptoms of acquired psychiatric disorder merit increased ratings, and that he experiences a wide range of symptoms, which includes irritability, nightmares, night sweats, severe sleep disturbance, social isolation, difficulty creating or maintaining relationships, depression, anxiety, intrusive memories, social anxiety, low motivation, anhedonia, loss of appetite and weight loss, hypervigilance, difficulty performing activities of daily living, hearing voices at night, angry outbursts, daytime fatigue, flashbacks, paranoid and suspicious ideation, difficulty with concentration, and memory problems. A 50 percent rating is warranted where there is occupational and social impairment with reduced reliability and productivity due to symptoms such 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; and difficulty in establishing and maintaining effective work and social relationships. Id. In order to warrant a 70 percent rating, the evidence must show occupational and social impairment with deficiencies in most areas, such as work, school, family, relationships, judgment, thinking, or mood, due to symptoms such as, but not limited to, suicidal ideation; obsessional rituals which interfere with routine activities; impaired impulse control (such as unprovoked irritability with periods of violence); near-continuous panic or depression affecting ability to function independently, appropriately, and effectively; spatial disorientation; speech intermittently illogical, obscure, or irrelevant; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work-like setting); and inability to establish and maintain effective relationships. Id. In order to warrant a 100 percent rating, the evidence must show total occupational and social impairment, due to such symptoms as, but not limited to, 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 personal hygiene); disorientation to time or place; and memory loss for names of close relatives, own occupation, or own name. Id. Furthermore, the Global Assessment of Functioning (GAF) score is a scale reflecting the "psychological, social, and occupational functioning in a hypothetical continuum of mental health-illness." Richard v. Brown, 9 Vet. App. 266, 267 (citing Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV) at 32). A GAF score of 61 to 70 indicates some mild symptomatology (e.g., depressed mood and mild insomnia) or some difficulty in social, occupational, or school functioning (e.g., occasional truancy, or theft within the household), but generally functioning pretty well, with some meaningful interpersonal relationships. Scores ranging from 51 to 60 reflect moderate symptoms (e.g., flat affect and circumstantial speech, occasional panic attacks) or moderate difficulty in social, occupational, or school functioning (e.g., few friends, conflicts with peers or co-workers). Scores ranging from 41 to 50 reflect serious symptoms (e.g., suicidal ideation, severe obsessional rituals, frequent shoplifting) or any serious impairment in social, occupational, or school functioning (e.g., no friends, unable to keep a job). Prior to December 1, 2009 After a review of the evidence of record, the Board determines that an increased rating in excess of 50 percent prior to December 1, 2009 is not warranted. Indeed, while the Veteran had occasional symptoms that could support a higher rating, they did not, on balance, cause social and occupational impairment with deficiencies in most areas of his daily living. Specifically, during a VA examination in September 2005, the Veteran reported that, as a result of a traumatic episode from 2003, he felt emotionally disturbed and had a “permanent uncomfortable feeling” that caused him to not get along with others and ultimately quit his job working security at the Dallas airport. He also reported difficulty adjusting, depression, loss of energy, loss of appetite, and insomnia. The Veteran reported that he had experienced some improvement in his general attitude and feelings and denied suicidal or homicidal ideation. He also reported that he was living with his parents, was not dating anyone, did not participate too much in social life, drank alcohol, but not excessively, and did not care whether he found a new job. Furthermore, the Veteran informed the examiner that “any external noise that reaches him during the night makes him worried, and he has to check to see if the doors are carefully closed.” Finally, he reported that he was not able to enjoy his favorite activities like sports and he felt he lost his interest in enjoyable social activities. The examiner described the Veteran as very pleasant looking with a nonchalant or very unconcerned attitude and mild irritation during the examination. The Veteran did not know the current date and only appeared at the examination because he received a phone call reminding him, but he could not express any personal interest and reported having no plans for the future. The examiner noted that the Veteran had good contact with outside reality and did not present any “psychotic type of manifestation.” The Veteran did not appear to be anxiety-ridden and did not express interest in further counseling. The Veteran noted that he read the papers as a daily activity and did not experience manic feelings or panic attacks. His GAF score was between 55 and 60. The examiner reported that the Veteran had mild depression and PTSD feelings and opined that he was “quite capable” of “pick[ing] up a job.” The examiner noted that no files were received to review in conjunction with the examination. The Veteran underwent a second VA examination in June 2007 and reported that things had not improved since 2005. He reported that he would drink three or four beers per night and more on the weekends but denied that it impacted his social or occupational functioning. He did not report social or emotional problems when asked, but later noted that he had trouble sleeping and would get two or three hours of sleep per night, which resulted in fatigue. The Veteran noted that he would wake up frequently, had recurrent nightmares, and was easily started. He also reported intrusive thoughts and some avoidance of thinking of the incident, as well as difficulty recalling details of the event. Furthermore, he noted that he had a depressed mood for the last few years, experienced anhedonia, experienced increased anger and hypervigilance, and had a reduced appetite causing him to lose 20 pounds. He reported that he had a fairly limited social life, in part, because he was raising two sons on his own and working full-time, limiting time for social activities. He described his situation as fairly stressful. The Veteran reported suffering irritability that would lead to angry outbursts approximately two times per week, and sometimes he would throw things, yell, and spank his children for minor things, although he denied using excessive force or hitting them. The Veteran further reported that, although he felt depressed on some days and did not feel like getting out of bed, he was able to complete normal activities of daily living without impairment and “pushe[d] through.” He described having “good days and bad days” and informed the examiner that his depression could last for weeks at a time, but he denied crying spells. He reported getting a job at the post office, moving out of his parents’ home, getting a place of his own, and having a close relationship with his parents. The Veteran also reported that he would watch TV, follow sports, and take his children to a movie when he found time in his busy schedule for leisure. The examiner observed that the Veteran presented as depressed, disinterested, and tired, but that he appeared fit, well-dressed, and groomed. The Veteran was verbal and cooperative, had average intelligence, had clear speech, and had a generally logical, coherent, and relevant thought process. Although he showed signs of psychomotor slowing and some difficulty expressing himself clearly, he was oriented to time, person, and place, had good reasoning and judgment, had good verbal comprehension, and had a good fund of general information. He demonstrated a good capacity for simple arithmetic and performed average on the digit span task despite reported difficulty with concentration. Additionally, while the Veteran reported difficulty with memory, he was able to recall two out of three items after a five-minute delay, and both his short- and long-term memory appeared fair. He denied homicidal or suicidal ideation and did not demonstrate delusional thinking. The June 2007 examiner opined that the Veteran may have sometimes missed work due to depression despite only reporting missing work because of physical symptoms, and they noted that his depression appeared to have had at least moderate impact on his social life causing him to be fairly isolated. A GAF of 70 was assigned for PTSD and a GAF of 65 for depressive disorder. However, the examiner noted that the results of the administered Minnesota Multiphasic Personality Inventory – 2 exam were invalid because they were suggestive of exaggeration of symptoms and overreporting. Finally, the examiner stated that the Veteran’s capacity for adjustment was good and, despite some significant depression likely caused by his stressful life circumstances, his PTSD symptoms were only mild. The examiner reviewed the evidence of record, examined the Veteran, and considered the Veteran’s contentions in forming their opinion, making the examiner’s opinion highly probative. During a VA examination in July 2009, the Veteran reported he was experiencing severe insomnia and nightmares nightly; daily moderate fatigue; mild memory, concentration, and attention issues that occurred intermittently and for a short duration several times per week; moderate daily depression; severe frustration and irritability daily; severe flashbacks that occurred every two or three months and lasted a couple hours; and intrusive thoughts, hypervigilance, social avoidance, suspicious and paranoid ideation, and panic episodes that varied in duration and could be situationally triggered. He stated that he avoided socializing with anyone other than his immediate family, was isolated, and was frequently impatient with his children. He reported that he had few leisure interests but was in a committed relationship, which he described as “good,” for the past three years, and he took care of his two sons, with whom he would watch sports and interact with in his leisure time. Concerning his work, he reported fantasizing about harming his supervisor but did not have any plan or intent to do so, and at the time he was off work due to a toe injury. The Veteran reported that his impaired concentration and attention impacted his memory and functioning at work. Despite reporting severe symptoms, the examiner noted that the Veteran did not have impairment of thought process or communication, and did not have any delusions, hallucinations, or suicidal thoughts. The examiner did note that the Veteran was bothered by small noises and would check the doors and locks, check in on his children, and put the lights on, usually at night. However, the examiner also noted that the Veteran had no obsessive or ritualistic behaviors that interfered with routine activities and did not have any irrelevant, illogical, or obscure speech patterns. As for his memory and concentration impairment, the examiner described it as mild to moderate, noting that the Veteran required greater than normal effort to memorize information, and he would forget addresses at work, lose his keys and phone, and forget conversations with his girlfriend. The examiner also noted that the Veteran recovered “fairly quickly” from panic attacks and was able to calm himself down and resume activities. The examiner assigned the Veteran a GAF score of 58 and stated that the Veteran was able to maintain minimal personal hygiene and other activities of daily living. The July 2009 VA examiner opined that the Veteran had occasional decreased in work efficiency or intermittent periods of inability to perform occupational tasks due to PTSD signs and symptoms, but that he had generally satisfactory functioning as evidence by routine behavior, self-care, and ability to have normal conversation. This opinion is highly probative because the examiner reviewed the evidence of record, examined the Veteran, and considered his contentions in forming their opinion. Although the Veteran reported numerous and severe symptoms during the September 2005, June 2007, and July 2009 VA examinations, the evidence beyond the VA examinations does not show the level of impairment contemplated by a 70 percent rating. Medical records between August 2005 and September 2009 indicate that the Veteran sought treatment for a range of symptoms and was treated with periods of medication and counseling, but that his overall functioning did not demonstrate occupational and social impairment with deficiencies in most areas. Specifically, in August 2005, the Veteran sought treatment for symptoms of depression, severe insomnia, sadness, unrealistic guilt, nervousness, low energy levels, impaired concentration, anxiety, discomfort around large groups of people, avoidance behaviors, hypervigilance, mistrust of strangers, envisioning that he would “die soon,” and getting up throughout the night to check noises frequently. He was assigned a GAF score of 45. While the physician observed the Veteran as having a depressed and anxious mood as well as a blunted affect, he was noted to be alert, oriented, neatly dressed, well groomed, cooperative, easily engageable, having no psychomotor abnormalities, having normal speech with appropriate eye contact, having coherent and goal-directed thought processes with no hallucinations, delusions, or suicidal or homicidal ideation, having intact memory and concentration, having average intelligence, and having fair insight and judgment. In April 2008, the Veteran was seen with complaints of worsening depression, episodic anxiety, anhedonia, amotivation, lethargy, disturbed sleep, and loss of appetite. He was withdrawn and exhibited slow and monotonous speech during the appointment, but he denied thoughts of harming himself or others, he worked full-time at the post office, and he had supportive family and friends. Again, other than some depressed mood and blunted affect, his mental status examination was normal with no signs of anxiety, agitation, psychosis, lability, or cognitive defects. The mostly normal mental status examination in April 2008 is similar to observations made in May 2008, July 2008, and throughout 2009, although in January 2009, the physician noted that the Appellant had severe anxiety, depression, irritability, and inability to tolerate frustration. A February 2009 VA treatment record noted the Veteran presented with “moderate major depressive disorder and PTSD symptoms,” but he denied suicidal ideation. That same month, the Veteran underwent a cognitive evaluation for a traumatic brain injury (TBI) suffered during a traumatic event in 2003. The evaluator determined that while the Veteran’s testing demonstrated cognitive deficits, the level of deficit was likely not as severe as the testing suggested, evidenced by the Veteran’s performance at his job and 3.6 GPA in a master’s program. A March 2009 psychological evaluation suggested that the Veteran’s anxiety symptoms included feelings of agitation, nervousness, generalized fear, and internal turmoil, and that he may have had a significant level of anger, finding it difficult to control his temper. It also noted that he probably had feelings of tension and an inability to relax. His depression was reflected in his endorsement of the most severe responses, and his appetite and sleep disturbances were noted as a part of his depression symptoms. He reported that others described him as sad, apathetic, listless, and aloof. The examiner assigned him a GAF score of 48. Despite the March 2009 findings, the Veteran he was still employed at the post office despite being attacked by two dogs. He lived with his two sons and reportedly had a good relationship with his parents. Although his speech was monotonous but spontaneous and he had a depressed mood and flat affect, his behavior was appropriate to the situation. Additionally, his thought process was goal-directed and no evidence of confabulation or distractibility was noted, nor did the Veteran report homicidal or suicidal ideation. His recent and remote memory was intact, and he was oriented to person, time, and place. While the Veteran’s displayed symptoms were significant, the Board determines that they were most accurately contemplated by the 50 percent rating that he was assigned prior to December 1, 2009. Of particular note, the symptoms associated with a 70 percent rating are quite severe, as represented by symptoms such as suicidal ideation, obsessional rituals, severe difficulty communicating, and near continuous panic. It is reasonable to believe that such symptoms would be so severe, that even a layperson would be readily able to identify the impairment. Here, such severe impairment is not shown. Indeed, at medical appointments and VA examinations prior to December 1, 2009, the Veteran was generally engaging and predominantly interacted appropriately with physicians. Overall, while the Veteran exhibited some symptoms of a higher rating, including irritability, difficulty establishing relationships with others, insomnia, and panic attacks, a holistic review of the Veteran’s symptoms, especially in light of the Veteran’s clear, logical, and goal-oriented speech and thought processes without signs of psychoses, obsessive rituals, thought disorder, neglect of personal appearance and hygiene, and hallucinations or delusions, were better characterized by the 50 percent rating he received prior to December 1, 2009. See Vazquez-Claudio v. Shinseki, 713 F.3d 112, 115-117 (Fed. Cir. 2013). Next, although the general rating formula provides specific examples of symptoms that may result from various acquired psychiatric disorders, the Board emphasizes that its analysis should also consider any other relevant criteria outside of the rating code in order to determine the level of occupational and social impairment. Mauerhan v. Principi, 16 Vet. App. 436, 444 (2002). As such, the Board has also considered the extent to which there were other indications of occupational and social impairment, such as difficulty in adapting to stressful circumstances or the inability to establish and maintain effective relationships that may have caused deficiencies in most areas, to include social and occupational inadaptability. In this regard, the evidence shows that the Veteran’s acquired psychiatric disorders and their manifestations were adequately contemplated by the assigned 50 percent rating prior to December 1, 2009. As discussed, the Veteran had custody of his two young sons, and primarily cared for them independently. He was able to live with his parents for a period of time and reported good relationships with them but was able to eventually move out and live independently. He also maintained a romantic relationship for at least three years and described it as “good.” Although he reported that he sometimes would have angry outbursts, yell, and spank his children for minor behavioral issues, he reported spending time with them and watching sports in his leisure time, and never reported challenges to his custody of his children. Furthermore, he was described in the record as well-groomed and neatly dressed with mostly intact memory and at least average intelligence. Although he reported that he had memory and concentration issues that interfered with his ability to perform schoolwork or tasks at his job, he maintained A’s and B’s in his master’s program and had a job as a postal carrier from 2005 until November 2009. He was able to drive at least short distances and reported in July 2009 that he was able to maintain basic activities of daily living. Therefore, the evidence demonstrates that his level of social and occupational impairment was not deficient in most areas, even when factoring in other relevant criteria outside of the rating code. See Mauerhan at 444. Therefore, a rating in excess of 50 is not warranted prior to December 1, 2009. Since December 1, 2009 In a February 2012 rating decision, the Veteran’s rating was increased to 70 percent, effective December 1, 2009. Based on the evidence of record, the Board determines that an increased rating in excess of 70 percent since December 1, 2009 is not warranted. Indeed, while the Veteran has occasional symptoms that could support a higher rating, they do not on balance cause total social and occupational impairment. Specifically, the Veteran reported during a February 2011 VA examination that he medically retired from the post office in the previous year due to PTSD and described frequent harassment and verbal confrontations with management. He got married in March 2010 but reported that interactions with his spouse and three children were frustrating and that he did not want to be bothered. He noted that his spouse struggled to understand his difficulties and they had deficits in communication. Furthermore, he reported being isolated from his family and easily irritated with his spouse and children. He had lost interest in sex, was uncomfortable around others, and was distant from immediate family members. He also reporting losing interest in previously enjoyed activities including pursuit of his educational goals. He enjoyed watching sports on television but did not regularly involve himself in other leisurely activities. While he denied suicidal attempts, he reported that he had thoughts of not being alive. The Veteran was visibly agitated during the interview and was somewhat guarded, evasive, and apathetic toward the examiner’s questioning. There were also slight indications of functional impairment secondary to a loss of motivation and disinterest in social activities. Furthermore, he acknowledged feeling fatigued, depressed, and irritable. He reported sleep disturbance with nightmares, anger, and paranoia, and reported being jumpy while driving. The Veteran stated that he thought about his past military trauma constantly, and he demonstrated impairments in impulse control related to a recent history of alcohol abuse and a DWI charge. The Veteran had to withdraw from college and received a medical retirement from the post office last year due to a reported combination of PTSD and health problems. Finally, he reported only sleeping two-to-three hours per night with wakefulness along with primary insomnia. The examiner noted that the Veteran’s PTSD symptoms required constant medication Despite these observations and reported symptoms, the Veteran’s mental status examination was otherwise generally normal. He did not demonstrate impairment in thought process or communication, he denied experiencing hallucinations or delusions, he made fair eye contact, his auditory comprehension was intact, his appearance and hygiene were adequate, he denied imminent homicidal or suicidal ideation, his ability to maintain minimal personal hygiene and perform daily activities of living was intact, he was alert and fully oriented, and he denied experiencing panic attacks. The February 2011 examiner opined that the Veteran had occasional decrease in work efficiency or intermittent periods of inability to perform occupational tasks due to signs and symptoms, but that he was generally functioning satisfactorily (routine behavior, self-care, and conversation normal). The examiner also noted that the Veteran’s work history suggests that continuous human interaction would be quite difficult for the Veteran to tolerate based on his current psychiatric symptoms, but the he “is not totally unemployable secondary to his PTSD symptoms as he could likely function in an isolated environment, though he would need to be separated from others in an autonomous work position.” The examiner reviewed the evidence of record, examined the Veteran, and considered the Veteran’s contentions in forming their opinion, and it is generally consistent with the medical evidence of record demonstrating that the Veteran’s symptoms do not cause total social and occupational impairment. Therefore, the examiner’s opinion is highly probative. The Veteran underwent another VA examination in November 2019. He reported that he only receives about three hours of uninterrupted sleep per night because he has difficulty falling and staying asleep, and he regularly has nightmares of being killed. He stated that this leads to daytime fatigue. The Veteran also reported symptoms that include being easily frustrated, not wanting to be around people, avoiding others, spending most of his time in the house and behind locked doors, lashing out verbally, being very jumpy on the highway, having an inability to drive long distances and relying on his wife to drive him, having racing and negative thoughts, being suspicious of others (especially if someone appears “out of nowhere”), and having poor memory that makes remembering appointments difficult. Furthermore, he reported having anniversary reactions in the fall season, “is in and out of dark times,” has low motivation and a lack of interest in doing things, has difficulty with panic or anxiety attacks, and continues to drink periodically despite a history of alcohol abuse. The Veteran reported that he and his wife have been together since 2010, they relocated, and they have two children together in addition to the children they each had from previous relationships. He reported going to jail in 2014 for another DWI, and he has not worked since he medically retired. Furthermore, he reported that he has not attended school since the last evaluation. The examiner noted that the Veteran experiences recurrent, involuntary, and intrusive distressing memories of the traumatic event; recurrent distressing dreams in which the content of the dream is related to the event; dissociative reactions; intense or prolonged psychological distress at exposure to internal or external cues that symbolize or resemble the traumatic event; avoidance of efforts to avoid distressing dreams, thoughts, or feelings about the event or external reminders of the event; an inability to remember an important aspect of the event; persistent and exaggerated negative beliefs or expectations about himself, others, or the world; persistent, distorted cognitions about the cause or consequences of the traumatic event that lead the individual to blame himself or others; persistent negative emotional state; markedly diminished interest or participation in significant activities; feelings of detachment or estrangement from others; persistent inability to experience positive emotions; irritable behavior and angry outbursts typically expressed as verbal or physical aggression toward people or objects; reckless or self-destructive behavior; hypervigilance; exaggerated startle response; problems with concentration; sleep disturbance; depressed mood; anxiety; suspiciousness; panic attacks that occur weekly or less often; chronic sleep impairment; impairment of short and long term memory; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships; impaired impulse control; and intermittent inability to perform activities of daily living, including maintenance of minimal personal hygiene. Although the examiner observed that the Veteran had a depressed mood with an affect that was congruent to the topic, the Veteran was described as alert and neatly dressed with good eye contact and good rapport, having tight and goal-directed thought processes, having no suicidal or homicidal ideations, and having no delusions or hallucinations. As such, the examiner opined that the Veteran has occupational and social impairment with deficiencies in most areas, such as work, family relations, judgment thinking, and/or mood, but they did not opine that the Veteran has total social and occupational impairment. Because the examiner reviewed the evidence of record, examined the Veteran, and considered his contentions in forming their opinion, it is afforded significant probative value. While the Veteran reported numerous and severe symptoms during the February 2011 and November 2019 VA examinations, the evidence beyond the VA examinations does not show the level of impairment contemplated by a 100 percent rating. Medical records between December 2009 and August 2020 indicate that the Veteran continued seeking treatment for a range of symptoms that included continued chronic sleep impairment, frequent nightmares, irritability, social isolation, social anxiety, fatigue, low energy, motivation, and mood, loss of interest or pleasure in things, difficulty with concentration and memory, anxiety, heightened vigilance, crowd avoidance, having a “short fuse” and “often snapping verbally,” continued alcohol use, depression, intrusive thoughts, feelings of hopelessness and helplessness, and impaired appetite. He has been treated with periods of medication, counseling, and recommendations to abstain from alcohol use, and the Veteran reported periods of sobriety, but currently drinks occasionally. Specifically, the Veteran submitted a private medical opinion to the Social Security Administration (SSA) in January 2010 that noted that the Veteran experiences fatigue, insomnia, impaired appetite, and a severe limitation in the ability to deal with work stress. The physician opined that the Veteran has “good days and bad days,” and the bad days occur more than three days per month. However, the physician was taking physical impairments into consideration in addition to the symptoms of the Veteran’s PTSD, did not review the evidence of record, and did not evaluate the Veteran’s symptoms under the VA diagnostic code for evaluating disabilities. Therefore, this opinion receives no probative weight. Next, the Veteran underwent an SSA consultative examination in February 2010. The evaluator opined that the Veteran’s PTSD symptoms caused social impairment that compromised his ability to sustain working relationships with others, and that he was unable to complete a normal workweek without interruptions from psychologically based symptoms. They determined that the Veteran had a markedly limited ability to complete a normal workday, interact appropriately with the general public, get along with coworkers, and respond appropriately to changes in his work setting. However, the evaluator also noted that the Veteran had no episodes of decompensation of extended duration, and that, overall, he had only moderate limitations in restrictions of daily living, maintaining social functioning, and maintaining concentration, persistence, or pace. Although the evaluator opined social and occupational limitations, they did not indicate what evidence they reviewed in forming their opinion or whether they examined the Veteran. The evaluator also evaluated the Veteran under the Social Security standards for disability, rather than in accordance with the diagnostic codes for determining the level of disability for VA purposes. As such, the examiner’s opinion is less probative than that of the VA examiners. Next, the Veteran underwent an April 2010 Department of Labor (DOL) Worker’s Compensation Psychiatric evaluation, which noted that he had not worked since November 2009. He was described as having an irritable mood, but was alert, oriented, having an appropriate affect, and denying homicidal or suicidal ideation. The examiner noted that a dog attack at work brought back old memories, flashbacks, and nightmares of his traumatic in-service event, and that the Veteran continued to be depressed and very anxious. He reported trying to avoid people and situations. The evaluator assigned the Veteran a GAF score of 48 and opined that “his symptoms have interfered so much that it is unlikely that he will be able to go back to his employment. His symptoms also interfered with his activities of daily living, and he does not leave his home…and is isolating.” The DOL evaluator was not evaluating the Veteran within the framework of VA standards for determining disability, and there is no evidence that the evaluator reviewed the Veteran’s entire evidentiary record in this matter before forming their opinion. Furthermore, their opinion is internally inconsistent with the examination results, as the evaluator noted that the Veteran was cooperative with good eye contact and casual dress, and is able to cook, clean, do laundry, handle his mail, drive minimally, and shop occasionally, indicating that he is able to perform activities of daily living and interact with people to some degree in places like the store or while driving short distances. As such, this opinion is less probative than that of the VA examiners. Furthermore, in June 2010, the Veteran underwent an evaluation for the Office of Personnel Management (OPM), and the evaluator opined that, because of the Veteran’s physical and psychological conditions, he is “totally disabled and cannot perform any type of work.” They noted that the Veteran’s appearance was appropriate but that he appeared depressed and spoke with a sense of hopelessness and detachment. The Veteran reported that he experiences sleep disturbance, excessive worry, intense anxiety, panic episodes, social anxiety, intrusive thoughts, flashbacks, nightmares, depression, lack of pleasure, attention deficit, feeling guilty, an inability to relax, concentration and memory problems, suicidal ideation, anger, repeating thoughts, racing thoughts, and excessive worry. While the evaluator examined the Veteran in person, there is no indication that they reviewed the other evidence of record in forming their opinion rather than simply forming their opinion based on one examination and the Veteran’s subjective complaints. Additionally, the evaluator indicates that their opinion is based on both the Veteran’s physical and psychological conditions, rather than whether his psychological symptoms alone result in total occupational impairment. As a result, the evaluator’s opinion is of little probative value. After the June 2010 evaluation, OPM found that the Veteran was “disabled for [his] position as a PT City Carrier, due to PTSD only.” This opinion is of no probative value because it is only determining that the Veteran is disabled regarding a specific job, and it is making this determination in accordance with the standards under a different and separate administrative agency, rather than in accordance with VA diagnostic codes for determining the severity of a disability. In April 2011, the Veteran’s private physician opined that the Veteran’s psychiatric disorders make him totally disabled and unable to work. This opinion is of little probative value because there is no indication that the physician reviewed the evidence of record before forming their opinion, nor is there any indication that they evaluated total occupational and social impairment under DC 9411 in accordance with VA standards for determining the severity of service-connected acquired psychiatric disorders. Additionally, in a December 2014 mental health clinic note, the Veteran reported that he had not been able to work. However, he reported that he helped his wife care for their young baby, attended AA meetings, and took online classes. The Veteran was alert and oriented with good concentration, intact memory, no homicidal or suicidal ideation, normal speech, no paranoid delusions, and logical, coherent, and goal-directed thought processes. While the Veteran’s medical records between December 2009 and August 2020 demonstrate that the Veteran consistently sought treatment for the aforementioned symptoms, he was at times observed as depressed, anxious, or irritable with a sometimes guarded or flat affect and low mood, and he had some observed concentration or memory issues, mental status examinations were otherwise normal. The Veteran was primarily described throughout the record as alert, oriented, neatly groomed, calm, cooperative, having normal speech, having a linear and goal-oriented thought process, having appropriate thought content, having fair judgment and insight, having intact memory and concentration, and having no suicidal ideation, homicidal ideation, delusions, or hallucinations. Although he was diagnosed with an alcohol use disorder and received multiple DUI arrests which led to a period of incarceration, he reported attending AA meetings and having a sponsor at times, maintaining periods of sobriety, or drinking moderately when he began drinking again. The Veteran regularly reported taking care of his young children that live with him while his wife works, and he reported being able to drive short distances despite long-distance driving making him too anxious. Finally, the Veteran was treated with various medications and counseling, but never attempted suicide, had no reported violent altercations, and was never hospitalized for psychological symptoms. While the Veteran reported some significant symptoms, the Board determines that they were most accurately contemplated by the 70 percent rating he is currently assigned. Of particular note, the symptoms associated with a 100 percent rating are quite severe, requiring total social and occupational impairment, as represented by symptoms such as gross impairment in thought processes or communication, peristent delusions or hallucinations, grossly inappropriate behavior, persistent danger of hurting oneself or others, inability to perform daily activities of living, and memory loss for names of close relatives or one’s own name. Like with a 70 percent rating, it is reasonable to believe that such symptoms would be so severe for a 100 percent rating, that even a layperson would be readily able to identify the impairment. Here, such severe impairment was not shown. Indeed, at the February 2011 and November 2019 VA examinations, the Veteran had adequate hygiene and grooming, showed no evidence of suicidal ideation or obsessive-compulsive behaviors, showed goal-directed thought processes, had at least average intelligence, was able to perform at least some activities of daily living and take care of his children, and showed no evidence of delusions or hallucinations. Overall, while the Veteran may exhibit some symptoms of a higher rating, including irritability and a short tempter with his wife and children, social isolation, substance abuse that led to DUI arrests, and chronic sleep impairment, a holistic view of the Veteran’s clear, logical, and goal-oriented speech and thought processes without any signs of psychosis, thought disorder, hallucinations, or delusions, are better characterized by the 70 percent rating he has received since December 2009. See Vazquez-Claudio v. Shinseki, 713 F.3d 112, 115-117 (Fed. Cir. 2013). Next, the Board considered other relevant criteria outside of the rating code in order to determine the level of social and occupational impairment. See Mauerhan at 444. The Veteran reported that he has chronic sleep impairment and constant fatigue and low motivation that make doing activities of daily living difficult. He also reported that he has irritability and a short temper that have led to reported incidents of snapping at his cousin, becoming irritable with his wife and children, throwing things, and spanking his children over minor incidents. He also reported that his poor memory and concentration made it too difficult for him to work or finish tasks around the house, and he has lost interest in doing leisure activities he enjoys like watching sports. Finally, he reported that he is suspicious of others and anxious around crowds, so he avoids leaving the house and sometimes locks himself alone in rooms at home or wakes up throughout the night to check noises and lock doors. Despite reporting these difficulties, he reported in December 2009 that he has a good family support system, and in September 2017 described his relationship with his wife as “supportive.” He was able to live with his cousin at one point, demonstrating an ability to be around others. In January 2018, the Veteran reported that he was going to be responsible for taking care of his three children independently while his wife was out of town for training, and he reported throughout the entire record that he is responsible for caring for the children while his wife works from home. In December 2009 and September 2011, he reported watching sports for leisure activity, and in September 2017 he reported that he wanted to get back into yoga. He also reported attending AA meetings and reported in August 2011 that he had a sponsor, both of which require some degree of interaction with others. While the Veteran reported during the November 2019 VA examination that he had not returned to school since the last evaluation in February 2011, the Veteran’s academic records demonstrate that he completed his master’s degree in Community Counseling in May 2018 with a 3.57 GPA. Furthermore, in January 2018, he reported passing a peer specialist exam. The Veteran’s ability to care for his children, maintain a good relationship with his wife, attend AA meetings, and complete a master’s degree are not consistent with a finding that the Veteran has total occupational and social impairment. In considering the appropriate disability ratings, the Board has also considered the statements from the Veteran, his wife, and his former employer that his service-connected psychiatric disorders are worse than they have been rated throughout the period on appeal, including that his disabilities cause impairments in his ability to engage in or maintain relationships, irritability and angry outbursts, and fatigue and depression that prevent him from completing tasks. However, the Board finds these statements of limited probative value. While the Veteran, his wife, and his former employer, as lay persons, are competent to report observed symptomatology as it comes to them through their senses, they are not competent to identify the specific level of the Veteran’s service-connected disability according to the appropriate diagnostic codes. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994); see also Cartwright v. Derwinski, 2. Vet. App. 24, 25 (1991) (“although interest may affect the credibility of testimony, it does not affect competency to testify”). On the other hand, such competent evidence concerning the nature and extent of the Veteran’s psychiatric disorders has been provided by the medical personnel who have examined him during the current appeal and who have rendered pertinent opinions in conjunction with the evaluations. The medical findings (as provided in the examination reports) directly address the criteria under which these disabilities are evaluated and are highly probative. The Board concludes that the weight of the evidence is against the claim for increased rating in excess of 70 percent since December 1, 2009, and there is no doubt to be otherwise resolved. See Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). The appeal is denied. 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. B.T. KNOPE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Veltri, Associate Counsel