Citation Nr: 21007865 Decision Date: 02/10/21 Archive Date: 02/10/21 DOCKET NO. 11-25 673 DATE: February 10, 2021 ORDER Entitlement to an initial rating in excess of 30 percent prior to September 14, 2014, and in excess of 70 percent from September 14, 2014 to December 3, 2019, for posttraumatic stress disorder (PTSD) is denied. FINDINGS OF FACT 1. For the appeal period prior to September 14, 2014, the Veteran’s PTSD manifested in occupational and social impairment with occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks without occupational and social impairment with reduced reliability and productivity, occupational and social impairment with deficiencies in most areas or total occupational and social impairment. 2. For the appeal period from September 14, 2014 to December 3, 2019, the Veteran’s PTSD manifested in occupational and social impairment with deficiencies in most areas without total occupational and social impairment. CONCLUSION OF LAW The criteria for an initial rating in excess of 30 percent prior to September 14, 2014, and in excess of 70 percent thereafter, 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 FINDINGS AND CONCLUSION The Veteran had active service from November 1973 to May 1988. He had an additional period of service from May 1988 to April 1996 that is dishonorable for VA purposes. These matters come to the Board of Veterans’ Appeals (Board) on appeal from a March 2010 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) Muskogee, Oklahoma. Jurisdiction of this appeal is currently with the RO in Phoenix, Arizona. This case was most recently before the Board in August 2018, at which time the appeal was remanded to the Agency of Original Jurisdiction (AOJ) for further development. The case has now been returned to the Board for appellate action. As noted in the prior Board remands, the Veteran requested a Board hearing and the claim was previously remanded to afford the Veteran the requested hearing. See VA Form 9, September 14, 2012 (requesting a Board hearing); see May 2014 Board remand (remanding the claim to schedule the requested Board hearing). The Board provided the Veteran an opportunity to present evidence in lieu of a hearing, and granted an extension. See January 2016 correspondence; see Board remand, October 6, 2017. However, the hearing was determined to be infeasible due to the Veteran’s incarceration. See Board remand, August 24, 2018. The Board notes that the Veteran remains incarcerated, and is not expected to be released in the near future, and as such, the requested Board hearing remains infeasible. In a May 2020 rating decision, the AOJ increased the Veteran’s rating for his PTSD to 70 percent effective September 14, 2014, and 100 percent effective December 3, 2019. As this does not represent a full grant of the benefits sought with respect to his claim for an increased rating for PTSD for the appeal period prior to December 3, 2019, the claim has been recharacterized as shown on the cover page of this decision, and the claim remains on appeal. AB v. Brown, 6 Vet. App. 35 (1993). Increased Rating - PTSD The Veteran generally contends that his PTSD symptoms are more severe than contemplated by the rating assigned. Specific argument in support of this appeal has not been provided. Disability ratings are determined by application of the criteria set forth in VA’s Schedule for Rating Disabilities, which is based on average impairment of earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. When a question arises as to which of two ratings applies under a particular diagnostic code, the higher rating is assigned if the disability more closely approximates the criteria for the higher rating. Otherwise, the lower rating applies. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. 38 C.F.R. § 4.3. 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). The Veteran’s entire history is considered when assigning disability ratings. 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). A review of the recorded history of a disability is necessary to make an accurate rating. 38 C.F.R. §§ 4.2, 4.41. The regulations do not give past medical reports precedence over current findings where such current findings are adequate and relevant to the rating issue. Francisco v. Brown, 7 Vet. App. 55 (1994); Powell v. West, 13 Vet. App. 31 (1999). The Board will consider entitlement to staged ratings to compensate for times since filing the claim when the disability may have been more severe than at other times during the course of the claim on appeal. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). The assignment of a particular diagnostic code is dependent on the facts of a particular case. See Butts v. Brown, 5 Vet. App. 532, 538 (1993). One diagnostic code may be more appropriate than another based on such factors as an individual’s relevant medical history, the current diagnosis, and demonstrated symptomatology. In reviewing the claim for a higher rating, the Board must consider which diagnostic code or codes are most appropriate for application in the veteran’s case and provide an explanation for the conclusion. See Tedeschi v. Brown, 7 Vet. App. 411, 414 (1995). The Veteran’s PTSD is rated under the General Rating Formula for Psychiatric Disabilities (General Formula). 38 C.F.R. § 4.130. 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 noncompensable rating is warranted if a mental condition has been formally diagnosed, but symptoms are not severe enough either to interfere with occupational and social functioning or to require continuous medication. 38 C.F.R. § 4.130, Diagnostic Code 9411. A 30 percent rating is warranted for occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events). Id. 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. Id. A 70 percent rating is warranted if the disability is productive 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 interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); inability to establish and maintain effective relationships. Id. A schedular maximum 100 percent rating is warranted if the disability ir productive of 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. 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 June 2020. As such, the DSM-5 applies, and the GAF scores will not be considered. A review of the record reveals that the Veteran sought mental health treatment from VA and other government 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. In a July 2009 statement, the Veteran stated that his PTSD was being treated with medication, had difficulty with certain sounds that caused him to jump, and felt that his heart skipped a beat, felt he was on alert or on the defense due to loud or sudden noises and had difficulty with work due to concentration issues with loud or sudden noises. In a September 2009 statement, the Veteran stated that his PTSD had been untreated for years because he had difficulty discussing his stressors, that he lived with his stressors on a daily basis, was treated with medication but coped he could and that he continued to suffer due to his mental health symptoms. In an October 2009 statement, the Veteran stated that it had been very hard for him to discuss his stressors, was on guard and had difficulty with loud noises and experienced nightmares related to his military service. At a December 2009 VA examination, the Veteran reported he had poor sleep, slept about two and a half hours a night, and did not feel rested. He reported he was easily distractible and awakened, and had nightmares many nights. Some of his nightmares were about receiving hostile fire from an enemy, although he had never been in that situation but he was in situations of live fire during training exercises resulting in deaths of people he knew. He had intrusive thoughts, mainly about a friend who was killed in a motor vehicle accident during his active service. He indicated that he had trouble with close emotional connections with people, frequently felt cut off and separate from others, jumped to a greater-than-average extent at loud noises, heightened arousal and alertness with metal-to-metal sounds, always on guard, hyperaware of surroundings, somewhat depressed on occasion, and irritable at times. The Veteran was incarcerated at the time of the examination. The guards who accompanied the Veteran for examination indicated the Veteran would have depressed mood resulting in the Veteran staying in his cell for days at a time, and not engaging in any available activities; and that he would be quite irritable from time to time. The Veteran became emotional when speaking of the stressor event during active service. He stated he had very few friends, and described himself as a loner; and he did not get involved in activities in prison, although there were quite a few he could be involved in. He attended church regularly. The Veteran did data entry work in prison, and had been doing this work for fourteen years; and was moderately good at this type of work. He was not taking any mental health medications at this time. The Veteran reexperienced and had intrusive thoughts on a regular basis regarding his military stressors. Mental status examination during the December 2009 VA examination showed the Veteran was casually and appropriately dressed, oriented to all spheres, that his mood was within normal limits with slight presence of some depressive features, that his short-term memory was fair to poor, that his attention and concentration normal and that he had no problems with thought disorder. Examination also noted that the Veteran did not have hallucinations or delusions, that he had a mixed set of negative emotions when thinking about his military stressors, variable appetite, that his eye contact was mostly good, that he had some historical suicidal ideation, but no suicidal ideation presently and denied homicidal ideation or intent. The Veteran handled cognitive testing very well, to include good verbal analysis skills and he was able to engage in verbal abstracting very well. The examiner noted no impairment of thought process or communication on the examination as a whole, although noting that his short-term memory was not very good. The examiner diagnosed mild PTSD, and noted that the Veteran’s social activities were somewhat limited due to his PTSD, although it was difficult to assess due to the Veteran’s incarceration. He appeared to be engaged in work, but it was difficult to evaluate the degree to which the Veteran’s PTSD might have had an influence on his work capacity. The examiner noted the Veteran stayed in his cell at times, generally had poor sleep, and overall opined that his PTSD produced a mild degree of dysfunction in terms of social and work capacity. An October 2010 prison treatment record indicates the Veteran stopped taking his anti-depressant medication and did not have suicidal ideation nor hallucinations. At a June 2011 VA examination, the Veteran presented with PTSD symptomatology that included intrusive thoughts, nightmares about combat experiences, even though he was never in direct combat, severe depressed every day, poor appetite and poor ability to concentrate. The Veteran reported he typically stayed awake, tossing and turning, every night; and would fall asleep in the early morning for five or six hours. The Veteran attributed a lot of his worsening depression to severe and chronic pain related to headaches and joint pain, and other physical ailments. Additionally, two of the Veteran’s best friends in prison had died. He was taking medication for his mental health symptoms, but reported he felt “drugged” and did not like them. He attended weekly classes to deal with his depression and anxiety; attended church approximately twice per month; and had no other mental health treatment since his prior VA examination. He remained incarcerated, and had recently developed some relationships with his children through letters and phone calls. He reported having friends in prison, and tried to help other prisoners with their problems. The Veteran had not had any jobs in prison since his surgery approximately one year prior, and reported that he was unable to work primarily due to physical pain and overall poor health. He spent most of his time going to classes and volunteered in the literacy program. He spent a lot of his time reading alone. The examiner noted there had been no significant change in social or occupational functioning since his last VA examination. Mental status examination conducted in the June 2011 VA examination showed the Veteran presented with long, well-kept braided hair and a somewhat long gray beard, that he had excellent personal hygiene but fair grooming, that he explained he grew his hair long and wore the beard to adapt to his environment and that he initially appeared to try to take control by asking the examiner to sit down and offering a cold beverage. The examiner noted that the Veteran wore sunglasses throughout the interview due to medical reasons and that he had sad affect, depressed mood; poor appetite, poor sleep, diminished ability to think and concentrate. The examiner further noted no signs of a thought disorder, that the Veteran denied hallucinations and delusions, that there was no inappropriate behavior, that he denied suicidal and homicidal ideation and that there was no impairment of thought process or communication. The examiner diagnosed PTSD and depressive disorder, and noted the Veteran continued to present with recurrent intrusive thoughts, avoidance of thoughts and feelings related to his military stressors and continued to have diminished participation in activities. The Veteran had friends but kept himself detached from others. He also had persistent symptoms of increased arousal including irritability, difficulty concentrating, and insomnia. The examiner opined the Veteran continued to have moderate impairment with respect to social and occupational functioning; and noted the Veteran had a few friends and was willing to try to help others, and was no longer working due to physical ailments. The Veteran was able to maintain personal hygiene and basic activities of daily living. In an August 2011 statement submitted by the Veteran’s friend, T.R., T.R. stated that the Veteran was a friend for about a year and that the Veteran treated people as if they were his own family; taught classes to help other veterans; seen him become angry, and then forgiven the person who angered him; participated in most, if not all of the programs available to him, even when sick; had genuine love; was kind-hearted even on his worst days; grumbled quietly; had a lot of faith; and overall had a good experience with the Veteran. T.R. indicated the Veteran had faults, but would admit the faults and seek forgiveness when needed. Prison treatment records from May 2011, October 2011, and November 2011 indicate that the Veteran’s PTSD symptoms included stress, sensitivity to noise and smells, difficulty with sleep, agitation, near panic symptoms that were amplified by his mind, had contact with his family, depression, moderate high anxiety, adjustment issues, flashbacks and sleep pattern disturbance. In an April 2012 letter by C.C., the law library supervisor at the prison where the Veteran resided, C.C. stated the Veteran did not have any disciplinary actions whatsoever in his 21 years incarcerated; was dedicated to helping other prisoners with basic living skills, such as reading, writing, and math; volunteered with the geriatric barracks and that he treated his PTSD. In a September 2014 letter from L.M., the Veteran’s treatment specialist in prison, L.M. stated that the Veteran regularly attended the trauma group on a weekly basis for about 18 months, worked on his moods and ways to give back to others, reported he grew from being in the group, and gained insight and did not have any disciplinary actions throughout his incarceration. Prison treatment records from September 2014 and October 2014 indicate the Veteran had depression, anxiety, breathing difficulties related to anxiety and was teary-eyed at times. In a May 2016 statement, the Veteran stated that he experienced nightmares, woke up gasping for air and calling out for his mother, woke up in tears and felt that his “will to live” was at “death’s door.” A May 2016 prison treatment record indicates that the Veteran had PTSD symptoms that included sleeplessness, bad dreams or nightmares, sweating at night, panic attacks and chest pain. In a December 2016 statement, the Veteran stated that he could no longer work beginning in 2010, and was medically unassigned in 2012 due to a combination of his PTSD and other issues; and that he was essentially considered 100 percent totally and permanently unable to work any “9-5 job in prison or out of prison.” He stated he suffered great distress, chronic bereavement of deaths and the loss of his job, reexperienced trauma events, had major sleep problems, anxiety, panic attacks, difficulty in concentration, emotional lability and severe head and chest pain. In an August 2017 statement, the Veteran stated he had panic attacks four to five times a week, had nightmares, slept only one to two hours per night, experienced severe head pain, dizziness, night sweats, fatigue, and grinded his teeth, had difficulty with short- and long-term memory and could not work. In a February 2018 statement, the Veteran added that his PTSD symptoms included major anxiety, panic attacks, sleeplessness, nightmares, night sweats, shortness of breath, head and chest pain, severe depression, sleep impairment, dizziness, fatigue, teeth grinding, impairment of short- and long-term memory and an inability to work. Further review of the record shows that the Veteran receives treatment from other government treatment providers for various disabilities, to include his PTSD. 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 in excess of 30 percent prior to September 14, 2014 and in excess of 70 percent for the appeal period from September 14, 2014 to December 3, 2019 is not warranted. In this regard, the Board finds that such disability was manifested by occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by continuous medication prior to September 14, 2014 and occupational social impairment with deficiencies in most areas for the appeal period from September 14, 2014 to December 3, 2019. For the appeal period prior to September 14, 2014, the Veteran’s PTSD did not manifest occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, occupational and social impairment with reduced reliability and productivity or occupational and social impairment with deficiencies in most areas. The Veteran consistently presented with diminished participation in activities, and often kept himself detached from others. However, the Veteran was shown to regularly attend church, worked until 2010 when his physical ailments prevented working, and had a few friends. Notably, an August 2011 statement submitted on behalf of the Veteran by his friend, T.R., it was indicated the Veteran taught classes to help others, engaged in almost all of the programs available to him, and showed a genuine love, kindness, and forgiveness towards others. Moreover, T.R. noted that the Veteran could recognize his faults and ask for forgiveness when appropriate. Also of note, employees of the prison where the Veteran was incarcerated indicated the Veteran did not have any disciplinary actions in over two decades of incarceration, attended weekly trauma meetings for a time, and helped other prisoners with basic life skills, such as, reading, writing, and math. The Veteran also volunteered in the geriatric barracks during this period on appeal. In addition, the Veteran specifically reported at his December 2009 VA examination that he had been working in data entry for the prison for 14 years, and he was moderately good at this type of work. Moreover, at his June 2011 VA examination, the examiner found the Veteran had moderate impairment in social and occupational functioning, and was no longer working as a result of his physical ailments. Therefore, the Board finds that the Veteran’s PTSD manifests as occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, occupational and social impairment with reduced reliability and productivity. For the appeal period prior to September 14, 2014, impairment to mood was demonstrated as the Veteran reported chronic sleep impairment and disturbance, an exaggerated startle response, and decreased social isolation. Specifically, he reported that he could only sleep a few hours a night, had difficulty with loud noises that caused him to jump and his heart skip a beat, and that he had difficulty with depressive symptoms that caused the Veteran to isolate in his cell. Moreover, the Veteran reported he had nightmares, was easily distracted and awakened, had intrusive thoughts, difficulty having close emotional connections with others, and frequently felt cut off from others. In this regard, the Veteran was incarcerated throughout the period on appeal, and was shown to not engage in any available activities in his unit, although there were many activities available for him. Some impairment to social relations was shown by the Veteran’s reports of having few friends, staying in cell for days at a time, and feeling like a “loner.” No impairment to work or thinking was demonstrated. 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, social and occupational impairment with deficiencies in most areas for the appeal period prior to September 14, 2014 is not warranted. For the appeal period from September 14, 2014 to December 3, 2019, impairment to mood was demonstrated as the Veteran reported continued chronic sleep impairment and disturbances, and that he only slept at most five hours per night; and his sleep continued to be interrupted. The Veteran also reported continuing nightmares, hypervigilance, exaggerated startle response, and dislike of loud noises. Notably, in a May 2016 statement, the Veteran indicated he was losing his will to live. Moreover, the Veteran remained unemployed as he was incarcerated, and reported he continued to have anxiety, panic attacks, difficulty in concentration, emotional lability, and physical manifestations of his psychiatric symptoms. However, little to no additional or worsening impairment to social relations was shown. Impairment to work was shown by the Veteran’s reports that he could no longer work as a combination of his psychiatric and physical symptoms. Specifically, the Veteran reported he was “essentially considered 100 percent” disabled by the prison, and he remained medically unassigned. Judgment was not impaired as it was consistently found to be intact or good during the appeal period and thinking was not found to be impaired. School was not attempted during the appeal period. Therefore, the Board finds that the Veteran’s PTSD showed occupational social impairment with occasional with deficiencies in most areas from September 14, 2014 to December 3, 2019. 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 December 3, 2019. 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 on occasion; and has consistently denied any homicidal ideations. Homicidal or suicidal attempts were never attempted or started. 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. Notably, the June 2011 VA examiner noted the Veteran had excellent personal hygiene. Mental status examinations during the appeal period consistently found the Veteran’s grooming and hygiene to be appropriate, adequate or good. 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 that his PTSD is more severe than currently shown on examination; and the Board observes that the Veteran, while he was competent to report his observable symptoms, was not competent to report that the his mental health symptoms were 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 assertions that his symptoms of panic, anxiety, depression, nightmares, sleep disturbance, and exaggerated startle response warranted a higher rating. 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 additional staged ratings under Hart, supra is appropriate; however, the Board finds that his symptomatology was been stable throughout each period on appeal. Therefore, assigning additional staged ratings is not warranted. The Veteran nor his representative have 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). Additionally, the Board has considered whether an inferred claim for a total disability based upon individual unemployability has been raised pursuant to Rice v. Shinseki, 22 Vet. App. 447, 453-54 (2009). Under 38 C.F.R. § 3.341(b), a TDIU which would first become effective while a Veteran is incarcerated in a Federal, State or local penal institution for conviction of a felony, shall not be assigned during such period of incarceration. See 38 U.S.C. § 5313(c). The VA's General Counsel has noted that, "[t]he provision that became section 5313(c) was described in the legislative history of Pub. L. No. 96-385 as prohibiting an adjudication of [a TDIU] during the period of the Veteran's incarceration." VAOPGCPREC 13-97 (April 7, 1997) (citing Explanatory Statement of House Bill, Senate Amendment, and Compromise Agreement, 96th Cong., 2d Sess., reprinted in 1980 U.S.C.C.A.N. 3323, 3327). The Veteran has been continuously incarcerated throughout the appeal period based upon a felony conviction. As a result, any TDIU claim may not be adjudicated. Accordingly, the Board finds that the preponderance of the evidence is against the assignment of an initial rating in excess of 30 percent prior to September 14, 2014 and in excess of 70 percent from September 14, 2014 to December 3, 2019 for PTSD. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, supra. 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.