Citation Nr: 21012643 Decision Date: 03/04/21 Archive Date: 03/04/21 DOCKET NO. 12-15 279 DATE: March 4, 2021 ORDER Entitlement to an initial disability rating in excess of 70 percent disabling for posttraumatic stress disorder (PTSD) is denied. FINDING OF FACT The Veteran’s PTSD most closely approximates 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); and/or inability to establish and maintain effective relationships. CONCLUSION OF LAW The criteria for entitlement to an initial disability rating in excess of 70 percent disabling for PTSD have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.10, 4.125, 4.126, 4.130, Diagnostic Code (DC) 9411. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served in the United States Army on active duty from July 2005 to February 2010. The issue comes before the Board of Veterans’ Appeals (Board) on appeal from an April 2011 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). In the April 2011 rating decision, the RO granted the Veteran’s service connection claim for PTSD and assigned a 30 percent rating. During the pendency of the Veteran’s appeal, in a February 2014 rating decision, the RO increased the initial disability rating for the Veteran’s PTSD to 70 percent effective from February 14, 2013. An August 2017 rating decision assigned an effective date of February 4, 2010 for the award of the initial 70 percent evaluation. Accordingly, the Veteran is presently rated at 70 percent for the entire period on appeal. As the full benefit was not granted, the claim remains on appeal. See AB v. Brown, 6 Vet. App. 35, 38 (1993). The Board remanded the above claim in September 2016 to obtain the Veteran’s treatment records and to provide a contemporaneous examination to address the severity and manifestations of the Veteran’s psychiatric disorder. The Board again remanded the above claim in May 2018 to provide additional evidentiary development. There has been substantial compliance with the remand directives, and the appeal is again before the Board. Stegall v. West, 11 Vet. App. 268 (1998); Dyment v. West, 13 Vet. App. 141, 146-47 (1999). The Board notes VA amended the Schedule for Rating Disabilities dealing with mental disorders and its adjudication regulations to remove the outdated references to the American Psychiatric Association Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition (DSM-IV), and replace it with the Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition (DSM-5). However, as in this case, the provisions of this final rule do not apply to claims that were pending before the Board (i.e., certified for appeal to the Board on or before August 4, 2014), the United States Court of Appeals for Veterans Claims, or the United States Court of Appeals for the Federal Circuit on August 4, 2014, even if such claims are subsequently remanded to the AOJ. See 80 Fed. Reg. 14,308 (Mar. 19, 2015). Entitlement to an initial disability rating in excess of 70 percent disabling for PTSD The Veteran contends the symptoms of his PTSD warrant a higher evaluation, currently rated as 70 percent disabling. VA has adopted a Schedule for Rating Disabilities to evaluate service-connected disabilities. 38 U.S.C. § 1155; 38 C.F.R. § 3.321; see generally, 38 C.F.R. § Part IV. The basis of disability evaluations 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 percentage ratings are based on the average impairment of earning capacity and individual disabilities are assigned separate diagnostic codes. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Generally, the degree of disabilities specified are considered adequate to compensate for considerable loss of working time from exacerbation or illness proportionate to the severity of the several grades of disability. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities and the criteria for specific ratings. The schedule recognizes that disability from distinct injuries or diseases may overlap. See 38 C.F.R. § 4.14. However, the evaluation of the same disability or its manifestations under various diagnoses, which is known as pyramiding, is to be avoided. Id. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Any reasonable doubt regarding a degree of disability will be resolved in favor of the veteran. 38 C.F.R. § 4.3. When an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Nevertheless, the Board acknowledges that a claimant may experience multiple distinct degrees of disability that might result in different levels of compensation from the time the increased rating claim was filed until a final decision is made. See Fenderson v. West, 12 Vet. App. 119 (1999); see also Hart v. Mansfield, 21 Vet. App. 505 (2007). The Veteran’s psychiatric disorder is currently rated as 70 percent under DC 9411 of the General Rating Formula for Mental Disorders (General Rating Formula). 38 C.F.R. § 4.130, DC 9411. Under the General Rating Formula, 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); and/or 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; inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; and/or memory loss for names of close relatives, own occupation, or own name). Id. The Board notes the Veteran’s appeal was certified in March 2014 prior to August 4, 2014, and thus the DSM-IV criteria is considered, to include Global Assessment of Functioning (GAF) scores. Global Assessment of Functioning is a scale reflecting the psychological, social, and occupational functioning on a hypothetical continuum of mental health-illness. See Richard v. Brown, 9 Vet. App. 266, 267 (1996). A GAF score of 61 to 70 reflects some mild symptoms (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 reflects moderate symptoms, such as flat affect and circumstantial speech, occasional panic attacks, or moderate difficulty in social or occupational functioning (e.g., few friends or 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). Scores ranging from 31 to 40 reflect some impairment in reality testing or communication (e.g., speech is at times illogical, obscure, or irrelevant) or major impairment in several areas, such as work or school, family relations, judgment, thinking, or mood, (e.g., avoidance of friends, family neglect, and an inability to work). See Carpenter v. Brown, 8 Vet. App. 240, 242-44 (1995). Although GAF scores provide an efficient method in evaluating mental disorders, an assigned GAF score is not dispositive of the rating criteria used by VA. Rather, it must be considered in light of the veteran’s symptoms of a psychiatric disorder. See 38 C.F.R. § 4.126(a). Accordingly, an examiner’s evaluation of the level of psychiatric impairment, by GAF score or other means, is to be considered but is not determinative of the VA disability rating to be assigned. When determining the appropriate disability evaluation to assign for a mental disorder, the Board’s primary consideration is a veteran’s symptoms, but it must also make findings as to how those symptoms impact a veteran’s occupational and social impairment. Vazquez-Claudio v. Shinseki, 713 F.3d 112 (Fed. Cir. 2013). Because the rating criteria found in the General Rating Formula do not constitute an exhaustive list, the Board need not find the presence of all, most, or even some, of the named symptoms to award a specific rating. Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). However, all ratings in the General Rating Formula are associated with objectively observable symptomatology and the plain language of the regulation makes it clear that the veteran’s impairment must be “due to” those symptoms. Thus, a veteran may only qualify for a given disability rating by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 118 (Fed. Cir. 2013). The Veteran underwent a VA examination for PTSD in December 2010. The Veteran was under treatment for symptoms of PTSD, anxiety, and depression. The Veteran reported he experienced periods of depressed mood nearly every day, lasting most of the day. The Veteran reported he was married in 2007 and his marriage was going great. The Veteran reported that he enjoyed spending time with his wife and two children. The Veteran stated he had little contact with his sister and noted conflicts with his mother. The Veteran noted he had very few friends. He stated his family was more important than going out with friends. The Veteran noted visiting with his cousin about once a week, noting his cousin was his best friend. The Veteran reported no history of suicide attempts. The Veteran noted that he would lose his temper and had thoughts of violence, but he did not act on his violent urges. The Veteran said his anger was triggered by small things. The Veteran reported no problems with alcohol or substance use. The VA examiner noted the Veteran appeared clean, neatly groomed, and appropriately dressed. The Veteran noted he was able to maintain minimum personal hygiene. The VA examiner noted that the Veteran displayed normal psychomotor activity. The Veteran displayed unremarkable speech, which the examiner noted as spontaneous clear, and coherent. The Veteran presented with normal affect and attention intact. The VA examiner noted the Veteran displayed intact orientation to person, time, and place. On examination, the Veteran displayed normal memory. However, the Veteran appeared to be in an anxious mood. The Veteran noted that he was often preoccupied by thoughts and concerns about his children, financial issues, and his experiences in Iraq. The Veteran noted that he suffered from sleep impairment. He stated he was able to get to sleep but frequently woke from bad dreams or any movement from his wife. He noted he often dreamt about being in a combat environment. The Veteran reported experiencing panic attacks about once a month, but noted after being in a car accident, he experienced panic attacks every time he was in the driver’s seat of his vehicle. The Veteran stated that he was able to calm down within minutes of his increased anxiety and return to work. The Veteran reported no homicidal or suicidal thoughts. However, the Veteran noted that after bad fights with his wife, he questioned whether he would be better off dead. The Veteran noted he did not believe he would act on these thoughts. The examiner noted he exhibited fair impulse control with no episodes of violence. The December 2010 VA examiner noted the Veteran’s PTSD symptoms were controlled by continuous medication. Additionally, the examiner noted the Veteran’s symptoms were not so severe as to interfere with occupational and social functioning. The VA examiner noted the Veteran’s PTSD did not present total occupational and social impairment. The Veteran’s GAF score was reported as 80. In February 2013, the Veteran underwent another VA examination. The VA examiner confirmed the Veteran’s diagnosis of PTSD. The VA examiner noted the Veteran’s PTSD created occupational and social impairment with reduced reliability and productivity. The VA examination noted the Veteran remained married to his wife of six years. The Veteran noted his relationship with his wife and two young daughters was highly supportive but a struggle. The Veteran reported that he got angry over everything. He noted that he yells at his daughters and then regrets his actions. The Veteran’s wife indicated that the couple frequently argued but remained committed to the relationship. The Veteran reported that he distanced himself from his mother and sister due to his irritability. He noted he has no other significant social relationships or social outlets. During the examination, the Veteran reported working at a trucking company for the past year. He noted that he planned to transition to a warehouse position, which his employer thought would be a better fit for the Veteran because it offered a more relaxed environment and less interaction with others. The Veteran recounted a recent verbal altercation at work that the Veteran stated may have escalated to violence if he had not had his medication. The Veteran reported he worked at his previous job for a year. He noted leaving his previous trucking position after getting into a minor traffic accident that triggered anxiety, panic attacks, and nightmares about Iraq. The Veteran noted he received a week off and counseling after the accident but left his previous job shortly after returning to work due to his inability to manage his anxiety. The Veteran reported attending biweekly counseling sessions and taking medication to manage his symptoms. He noted without his medication he was more hostile and irritable. He experienced anxiety when he forgot his dose. The Veteran denied drug or alcohol abuse, though the Veteran’s wife noted the Veteran tends to go overboard once a month. The Veteran’s wife noted the Veteran’s intoxication led to verbal altercations. The Veteran expressed his biggest problem was irritability and his memory. He noted he was frustrated easily and will often forget things. The Veteran noted forgetting his pills and will often get lost while driving. The Veteran noted his mood is erratic and described his periods of depression as a feeling like he is floating through time. The Veteran reported that he had mild panic attacks daily but had fewer full-blown attacks since being on consistent medication. The Veteran’s wife noted during the examination that the Veteran will call from work in a panicked state, specifically noting when the Veteran forgot his pills. She noted the Veteran had panic attacks while driving. The Veteran noted being unable to sleep due to persistent fears that something terrible will happen to his family. The Veteran recalled several incidents of flashbacks to combat and noted he has dropped to the ground in reaction to loud noises. The examiner identified the Veteran’s symptoms and noted he displayed difficulty in establishing and maintaining effective work and social relationships. Additionally, the Veteran exhibited difficulty in adapting to stressful circumstances. The examiner recorded the Veteran’s GAF score of 50. During the clinical interview, the examiner observed the Veteran wore casual clothing and exhibited good grooming. The examiner noted the Veteran was alert and fully oriented, displaying no gross memory impairments. The examiner did note the Veteran displayed mild difficulties with attention. The Veteran was cooperative during the evaluation and interacted in a pleasant but blunted manner. The Veteran displayed limited eye contact and moderate psychomotor agitation. The examiner noted the Veteran’s mood was anxious, and his affect was flat, with periods of brief crying. The Veteran’s speech was normal in rate and tone. The Veteran speech was goal-directed and spontaneous, but often minimally elaborative. The Veteran displayed an organized thought process with no evidence of a formal thought disorder, hallucinations, delusions, mania, or pronounced obsessive-compulsive features. The examiner noted the Veteran displayed a fair insight into his PTSD and related emotions and behaviors. The examination reported the Veteran experienced no difficulties with average daily tasks due to his mental health issues. The examination noted the Veteran managed his financial affairs. The examiner noted the Veteran denied suicidal ideation and homicidal ideation. However, the Veteran noted that after arguments with his wife he will often express that he should die. The RO provided the Veteran a psychiatric VA examination in October 2016. The VA examiner again confirmed the Veteran’s diagnosis of PTSD. The VA examiner stated the Veteran’s PTSD created occupational and social impairment in most areas such as work, school, family relations, judgment, thinking and mood. The Veteran reported he remained married to his wife of nine years. The Veteran noted his relationship had its ups and downs, but he was thankful that his wife remained supportive. The Veteran noted that he often got angry, which he realized scared his children. He expressed remorse at frightening his daughters and apologized. The Veteran expressed that he experienced an overwhelming sense of depression during the previous year. The Veteran stated that over the previous four to five years his social life diminished. He noted that he did not want to do anything, though he noticed an improvement in his mood over the past month before the examination. The Veteran stated that his medications were adjusted and that seemed to help address his depression and worry. The Veteran experienced poor short-term memory. He noted that his memory involving his routine was normal, but he needed to write down novel experiences or he would forget. The Veteran noted working at a dairy plant. He previously worked as a truck driver hauling milk for another company but left that job because he did not like the variability and unpredictability of when he was able to come home. The Veteran reported that he was often anxious at work. He noted that he avoided interactions with co-workers and supervisors. The Veteran reported that he saw a therapist until two years prior to the examination. He stopped his sessions when he took the job as a truck driver. The Veteran noted he benefited from therapy and knew he would benefit from returning. The Veteran expressed he had no motivation to resume therapy but still received medication. For rating purposes, the VA examiner noted the Veteran displayed symptoms of depressed mood. The examiner noted the Veteran suffered anxiety, with panic attacks that occurred weekly or less often. The examiner noted the Veteran experienced sleep impairment. The examiner noted the Veteran displayed a flattened affect and disturbances of motivation and mood. The Veteran displayed impaired impulse control with unprovoked irritability and periods of violence. The Veteran displayed short-term memory impairment. The examiner noted the Veteran had difficulty in establishing and maintaining effective work and social relationships. Additionally, the Veteran exhibited difficulty in adapting to stressful circumstances. The VA examiner noted the Veteran appeared clean, neatly groomed, and appropriately casually dressed. The Veteran noted he was able to maintain minimum personal hygiene. The VA examiner noted that the Veteran displayed unremarkable psychomotor activity. The Veteran displayed spontaneous clear and coherent speech. The Veteran presented with a normal but blunted affect. The examiner noted the Veteran’s attention was intact. However, the Veteran appeared to be in a worrisome dysphoric mood. The VA examiner noted the Veteran displayed intact orientation to person, time, and place. The Veteran displayed normal memory on examination. The examiner described the Veteran’s thought process with an overabundance of thoughts constantly developing. The Veteran expressed that he was constantly aware of his surroundings, and he was searching for a means to escape if something bad happened. The examiner noted no evidence of inappropriate behavior, hallucinations, delusions, or obsessive-ritualistic behaviors. The examiner noted the Veteran denied suicidal ideation and homicidal ideation. However, the Veteran noted occasional passive thoughts that life might be better for his family without him. The examination reported the Veteran experienced difficulties with activities of daily life due to his mental health issues. The Veteran experienced severe impairment in household chores, shopping, and other recreational activities. The examiner noted the Veteran had a moderate problem driving. The examiner noted the Veteran’s psychiatric disorder prevented traveling and engaging in sports or exercise. Pursuant to the May 2018 Board remand, the RO obtained a September 2019 addendum opinion from the October 2016 VA examiner to provide a GAF evaluation of the Veteran’s psychiatric disorder applicable to the DSM-IV. The VA examiner provided the medical opinion that, as of the October 2016 examination, the Veteran experienced occupational and social impairment from symptoms warranting a GAF score between 41 and 50. VA provided an examination to address the Veteran’s psychiatric disorder in December 2019. The VA examiner provided a diagnosis of PTSD. Additionally, the examiner opined that the Veteran met the criteria for a diagnosis of Generalized Anxiety Disorder, and polysubstance use disorder. The Veteran reported that he self-medicated his symptoms with the use of alcohol, cannabis, and nicotine/tobacco. The VA examiner provided the opinion that the Veteran exhibited serious symptoms indicating serious impairment in social, occupational, or school functioning. The VA examination noted the Veteran remained married to his wife of 12 years. The Veteran described his relationship with his wife as pretty good. The Veteran noted that his family is “the only thing that keeps him together.” The Veteran added that his experiences in Iraq turned him into a “lifeless blob.” The Veteran denied having friends. He noted his childhood friends have died from medical conditions. The Veteran expressed his thoughts that he was the reason his friends have died. He added that those deaths kept him from wanting to make new friends. The Veteran noted that he worked for the previous two years as a local truck driver. He noted leaving his previous dairy plant job abruptly, feeling that he could not be there anymore. The Veteran expressed leaving his previous job was one of his major regrets of his life. The Veteran noted he is stressed out all the time while driving in his new job. The Veteran expressed that he struggles with his moods. The VA examiner noted the Veteran tearfully expressed that his anxiety was triggered by everyday life and he experienced significant anger. The Veteran noted that he had not experienced a panic attack in over a year. The Veteran expressed some suicidal ideation, but the Veteran answered that he would never act on it. The Veteran noted that he did not know what would happen after, and he did not want to appear as a coward. The Veteran denied any plan to take his own life or any homicidal ideation. For rating purposes, the VA examiner noted the Veteran displayed symptoms of depressed mood and anxiety. The examiner noted the Veteran experienced sleep impairment and mild memory loss, such as forgetting names, directions or recent events. The examiner noted the Veteran displayed disturbances of motivation and mood. The examiner noted the Veteran had difficulty in establishing and maintaining effective work and social relationships. The Veteran exhibited difficulty in adapting to stressful circumstances. The VA examiner noted the Veteran arrived early to the examination and was casually dressed and appropriately groomed. The Veteran was fully oriented. The Veteran was able to recall three of three words after delay and without prompt. The VA examiner noted that the Veteran was cooperative and provided good eye-contact. The Veteran displayed normal speech in rate and tone. The Veteran’s affect and mood were dysphoric and anxious. The examiner noted the Veteran’s attention was intact. The examiner described the Veteran’s thought process as generally organized, with no evidence of a formal thought disorder, hallucinations, delusions, or obsessive-compulsive features. The VA examiner noted the Veteran displayed fair insight for his PTSD and related emotions and behaviors. The examiner recorded the Veteran’s GAF score as 50, the top of the range indicating serious symptoms or any serious impairment in social, occupational, or school functioning. The records include the Veteran’s lay statements, submitted with his May 2012 substantive appeal form, noting he suffered short-term memory loss. He noted that his reactions are extreme to any negative situation. The Veteran stated that he did not have good familial relationships. He noted that he was easily irritated with his family and did not care to be around them anymore. The Veteran noted his marriage was a constant struggle due to his anger, anxiety and memory problems. The Veteran reported that arguments with his wife triggered suicidal thoughts. Additionally, the Veteran stated he had to leave his previous job as a truck driver because of extreme panic attacks and anxiety. The Veteran submitted a lay statement from his wife in May 2012. The Veteran’s wife noted the Veteran struggled with mental and emotional difficulties. The Veteran’s wife described the Veteran’s panic attacks while driving. She expressed worry about the Veteran’s short-term memory problems. The Veteran’s wife reported that the Veteran occasionally broke down into tears after forgetting something, and he expressed negative thoughts of his self-worth. The Veteran’s wife reported that after fights the Veteran expressed suicidal thoughts. She noted that although the Veteran has a good relationship with her, he barely has any relationships outside of his immediate family. The Veteran’s wife also noted anxiety and flashbacks negatively affected the Veteran’s job. The medical evidence of record shows the Veteran’s symptoms of PTSD with general anxiety disorder, and substance use disorder manifested over the period of appeal as: near-continuous panic or depression affecting the ability to function independently, appropriately, and effectively; impaired impulse control with instances of violence and irritability; difficulty in adapting to stressful circumstances (including work or a worklike setting); suicidal ideation; inability to establish and maintain effective relationships outside of his immediate family, and short-term memory impairment. During the pendency of the appeal, the Veteran exhibited GAF scores of 80, 50, and a range between 41 and 50, during which time he endorsed memory impairment, suicidal ideations, sleep impairment, hypervigilance, depression, isolation, anxiety, and irritability. As stated above, GAF scores are not dispositive, and rather, must be considered in light of the symptoms of the Veteran’s disorder. The Veteran’s GAF scores, when considered with all the evidence that bears on occupational and social impairment, indicate a range of moderate to severe difficulty in social or occupational functioning, as a whole more nearly approximating the criteria for a disability rating of 70 percent. 38 C.F.R. §§ 4.7, 4.130, DC 9411. After a review of the medical and lay evidence of record, the Board finds the Veteran’s psychiatric disorder has not manifested, at any time during the claim period, to the level of total occupational and social impairment required for a 100 percent disability rating under the General Rating Formula. 38 C.F.R. § 4.130, DC 9411. While the evidence of record demonstrates the Veteran has displayed inappropriate behavior and has shown periods of extreme impairment of impulse control leading to anger and potential violence, the evidence does not show the Veteran exhibited gross impairment of thought processes or communication. The medical evidence of record noted the Veteran did not experience persistent hallucinations, delusions, or grossly inappropriate behavior. The Veteran expressed regret and remorse for his anger and had a valid insight into his PTSD and anxiety disorder. Additionally, the Board is sympathetic to the Veteran’s noted suicidal ideation; however, the Veteran repeatedly noted during his VA examinations that he had no plan to act on his suicidal thoughts. As such, the Board notes the evidence of record does not show the Veteran is a persistent danger of hurting himself or others. The Board recognizes the Veteran’s wife’s May 2012 lay statement that the Veteran was unable to maintain relationships outside of the family. However, the Veteran has lived with his wife since 2004 and the record showed he considered his wife and their relationship to be supportive. Accordingly, the evidence of record shows the Veteran’s PTSD has not manifested as total social impairment. The record shows the Veteran experienced memory impairment; however, the Veteran’s daily routines were not affected. The Veteran’s memory loss was not so severe as to be memory loss of names of close relatives, own occupation, or own name. While the Veteran’s psychiatric symptoms presented problems with activities of daily living, including travel, exercise, and household chores, the Veteran always maintained minimal personal hygiene. The evidence of record did not show that he had a complete inability to perform activities of daily living, and the Veteran noted improvements with proper medication during the intermittent periods of increased anxiety and depression. Moreover, the Board finds the Veteran’s psychological disorder has not caused total occupational impairment. The Board acknowledges the Veteran’s anxiety and short-term memory issues demonstrated serious impediments to the Veteran’s employment. However, the Board notes the Veteran’s series of VA examinations showed the Veteran was able to maintain steady gainful employment during the duration of his appeal. The Veteran was able to return to driving a truck even after he regretfully changed occupations due to his anxiety attacks while driving. Accordingly, the Board finds that the Veteran’s symptoms of his psychiatric disorder have not manifested to the level of total occupational impairment. Although the Board acknowledges the Veteran’s PTSD has impaired the Veteran’s social relationships and impacted the Veteran’s ability to work, the evidence of record does not support a determination that the Veteran’s psychiatric disorder manifested as total social and occupational impairment. Accordingly, the Board finds that the probative evidence of record is against a disability rating in excess of 70 percent. In reaching this conclusion, the Board considered the doctrine of reasonable doubt; however, as the preponderance of the evidence is against a rating in excess of that currently assigned, the doctrine does not apply. See Gilbert v. Derwinski, 1 Vet. App. 49, 55-56 (1990). JENNIFER HWA Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A.V. Bona, 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.