Citation Nr: 21021899 Decision Date: 04/14/21 Archive Date: 04/14/21 DOCKET NO. 15-45 044 DATE: April 14, 2021 ORDER An initial compensable rating for migraine headaches is denied for the period prior to October 10, 2014. A higher disability rating of 30 percent for migraine headaches is granted from October 10, 2014. A disability rating in excess of 30 percent for migraine headaches is denied for the period from October 10, 2014 and thereafter. An initial rating in excess of 20 percent for left shoulder tendonitis is denied. An initial rating in excess of 10 percent for post-traumatic stress disorder (PTSD) is denied for the period prior to May 7, 2013. A disability rating of 50 percent is granted for PTSD from May 7, 2013 and thereafter. FINDINGS OF FACT 1. Prior to October 10, 2014, the Veteran’s service-connected migraines did not manifest in characteristic prostrating attacks. 2. From October 10, 2014 and thereafter, the Veteran’s service-connected migraines were manifested by characteristic prostrating attacks, averaging once a month. 3. The Veteran’s service-connected left shoulder tendonitis was manifested by subjective complaints of pain, left shoulder flexion to no worse than 135 degrees, and abduction to no worse than 65 degrees. 4. Prior to May 7, 2013, the Veteran’s service-connected PTSD resulted in occupational and social impairment with mild and transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by continuous medication. 5. From May 7, 2013 and thereafter, the Veteran’s service-connected PTSD resulted in occupational and social impairment with reduced reliability and productivity due to such symptoms such as impaired judgment; disturbances of motivation and mood, and difficulty establishing and maintaining effective work and social relationships. CONCLUSIONS OF LAW 1. The criteria for a compensable rating prior to October 10, 2014 for migraine headaches have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code 8100 (2020). 2. The criteria for a rating of 30 percent for migraine headaches, but no higher, from October 10, 2014, have been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code 8100 (2020). 3. The criteria for an initial rating in excess of 20 percent for left shoulder tendonitis have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5201 (2020). 4. The criteria for an initial rating in excess of 10 percent for PTSD were not met for the period prior to May 7, 2013. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.3, 4.20, 4.130, 4.132, Diagnostic Code 9411 (2020). 5. The criteria for a rating of 50 percent were met on and after May 7, 2013. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.3, 4.20, 4.130, 4.132, Diagnostic Code 9411 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 2006 to July 2013. On appeal is a September 2013 rating decision issued by a Department of Veteran Affairs (VA) Regional Office (RO). The Veteran challenges the rating assigned for his service-connected migraines, left shoulder tendonitis, and PTSD. When the matter was initially before the Board of Veterans’ Appeals in October 2018, the Board remanded for additional development to include obtaining treatment records, obtaining a new VA examination of the Veteran’s PTSD, and to consider evidence that was added to the Veteran’s claims file after the issuance of the January 2017 Supplemental Statement of the Case (SSOC). In November 2020, the Board remanded a second time to obtain the Veteran’s Social Security Administration records. The matter has now returned to the Board for appellate review. Duty to Notify and Assist The Veteran has not raised any issues with the duty to notify. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board... to search the record and address procedural arguments when the veteran fails to raise them before the Board”). The Board also finds that the duty to assist requirements have been fulfilled. All relevant, identified, and available evidence has been obtained, and VA has notified the appellant of any evidence that could not be obtained. Also of record are VA examinations conducted in December 2012, October 2014 and October 2016. The Veteran has not referred to any additional, unobtained, relevant, available evidence. Thus, the Board finds that VA has satisfied the duty to assist. No further notice or assistance to the Veteran is required to fulfill VA’s duty to assist in development. Smith v. Gober, 14 Vet. App. 227 (2000); Dela Cruz v. Principi, 15 Vet. App. 143 (2001); Quartuccio v. Principi, 16 Vet. App. 183 (2002). Increased Rating Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities. 38 C.F.R. Part 4. The Schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of or incident to service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. In considering the severity of a disability, it is essential to trace the medical history of the Veteran. 38 C.F.R. §§ 4.1, 4.2, 4.41. Consideration of the whole recorded history is necessary so that a rating may accurately compensate the elements of disability present. 38 C.F.R. § 4.2; Peyton v. Derwinski, 1 Vet. App. 282 (1991). Although the regulations do not give past medical reports precedence over current findings, the Board is to consider the Veteran’s medical history in determining the applicability of a higher rating for the entire period in which the appeal has been pending. Powell v. West, 13 Vet. App. 31 (1999). 1. Entitlement to an initial compensable rating prior to October 17, 2016, and a rating in excess of 30 percent thereafter, for migraine headaches. The Veteran’s migraines have been rated pursuant to the criteria of Diagnostic Code 8100. Diagnostic Code 8100 provides a 10 percent rating for headaches manifested by characteristic prostrating attacks averaging one in two months over the last several months. A 30 percent rating is warranted for headaches manifested by characteristic prostrating attacks occurring on an average once a month over the last several months. A 50 percent rating is warranted for very frequent completely prostrating and prolonged attacks productive of severe economic inadaptability. The rating criteria do not define “prostrating,” nor has the Court. Here, the Veteran was granted service connection for migraine headaches and assigned a noncompensable rating in a September 2013 rating decision. During the pendency of the appeal, in a November 2016 rating decision, the RO increased the rating to 30 percent effective October 17, 2016. As the disability rating assigned did not represent a total grant of benefits sought on appeal, the claim for an increase remained before the Board. AB v Brown, 6 Vet. App. 35, 39 (1993). After review of the medical and lay evidence in this case, the Board finds that (1) the Veteran is not entitled to a compensable rating for the period prior to October 10, 2014; and (2) the Veteran is not entitled to a rating in excess of 30 percent after October 10, 2014. In essence, the Board finds that the current ratings are to remain the same, but that the Veteran is entitled to an earlier effective date for the award of the 30 percent rating. The Veteran underwent a VA examination for headaches in December 2012 (prior to his discharge from active duty in July 2013). The examiner noted the Veteran reported migraine headaches with onset in 2008. The Veteran stated he remembers his head hurting so bad he cried himself to sleep. He described the pain as throbbing to bilateral temples, for which Tylenol was not effective. Since that time, he has had similar headaches, 1-3 times a week, that last hours and are relieved with sleep and/or rest. The examiner noted the Veteran stated he does not take any medications for this head pain, but in another section of the written report it states that the Veteran reported he has seen a neurologist who prescribed medication which he takes daily (topiramate). The Veteran underwent another VA examination for headaches on October 10, 2014. The examiner noted a diagnosis of migraine including migraine variants. The examiner stated the Veteran has prostrating attacks, once every month. In the remarks section, the examiner noted that the Veteran has about 2 migraine headaches per month and at least one of these lasts for 8 hours or so and is quite prostrating. As far as testing is concerned, the examiner noted a CT of the head was normal last year (2013) and that a neurological exam today was also normal. In closing, the examiner noted the Veteran’s migraine headaches are stable but symptomatic. The Veteran underwent another VA examination on October 17, 2016. The examiner noted the Veteran reported a history of migraine headaches which began during active service. He stated the pain affects the central forehead and extends to the temples bilaterally. He reported he has frequent headaches, including two in the last month. He takes over the counter Excedrin or Motrin with some benefit. He has not taken triptan but believes that he took a medication regularly to prevent headaches at one point. The examiner noted the Veteran has characteristic prostrating attacks of migraine headache pain once every month. The examiner stated these headaches are not productive of severe economic inadaptability as the Veteran has frequent migraine headaches but typically does not miss work as a result. VA treatment records from the Dallas VAMC are associated with the Veteran’s claims file. In summary, these records reflect the Veteran had occasional complaints of headaches. Lay evidence is also associated with the Veteran’s claim file. In his August 2014 Notice of Disagreement (NOD), the Veteran stated he had a characteristic prostrating headache at least once a month over the last several months and is entitled to a 30 percent rating. In his December 2015 substantive Appeal, the Veteran reported his headaches have increased in frequency to the rate of 2-3 incidents per month. The Board concludes that the evidence of record, in particular the three VA examinations noted above, establishes that the Veteran meets the criteria for a noncompensable rating until the date of his October 10, 2014 VA examination. As noted above, it was during this examination that an examiner first determined that the Veteran had prostrating attacks, and that these attacks occur once per month. As such, the Board finds that the Veteran’s migraine headaches continue to warrant a noncompensable rating prior to October 10, 2014, but from that date onward, the Veteran is entitled to a rating of 30 percent rating. In effect, the Board is granting an earlier effective date for the grant of 30 percent rating – it was effective October 07, 2016, but is now, with this order, effective October 10, 2014. The Board has also considered the Veteran’s lay statements. While lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), in this case, such an opinion falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). To the extent that the Veteran contends that his migraine headaches are more severe than evaluated, while he is competent to describe that he has migraine headache pain, he is not competent to report that his pain is of sufficient severity to warrant a certain evaluation under VA’s rating criteria because such an opinion requires medical expertise which he does not possess. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). As a result, the Board finds the results of the VA examinations to be more probative than the lay evidence, particularly the October 2014 and October 2016 VA examinations, as discussed above. In sum, the Board concludes that for the period on appeal prior to October 10, 2014, a compensable rating for migraines is not warranted. However, for the period from October 10, 2014 onward, a 30 percent rating for migraines is warranted. 2. Entitlement to an initial rating in excess of 20 percent for left shoulder tendonitis. The Veteran’s left shoulder tendonitis is currently rated under Diagnostic Code 5201 which governs limitation of motion. During the pendency of the appeal, the rating criteria for evaluating musculoskeletal disabilities under 38 C.F.R. § 4.71a were amended effective February 7, 2021. 85 Fed. Reg. 230 (Nov. 30, 2020). These amendments revised select diagnostic codes “to ensure that this portion of the rating schedule uses current medical terminology and provides detailed and updated criteria for the evaluation of musculoskeletal disabilities.” Id. Here, Diagnostic Code 5201 was revised by provide additional measurements for flexion and abduction to the existing rating criteria. The revisions are highlighted here in red. Different ratings are available for the dominant (major) and non-dominant (minor) side. Here, the Board notes the Veteran is right-hand dominant, and therefore the ratings for the minor side must be considered when considering impairment of his left shoulder. Under Diagnostic Code 5201, for the minor side, a 20 percent rating is warranted for limitation of motion to shoulder level (flexion and/or abduction limited to 90 degrees) or for motion limited midway between the side and shoulder level (flexion and/or abduction limited to 45 degrees); and, a maximum 30 percent rating is warranted for flexion and/or abduction limited to 25 degrees from the side. Here, the Veteran was granted service connection for left shoulder tendonitis in a November 2016 rating decision and assigned a 20 percent disability rating for the entire period on appeal. After review of the medical and lay evidence in this case, the Board finds that a disability rating in excess of 20 percent is not warranted for the Veteran’s left shoulder tendonitis. The Veteran underwent a VA examination of his left shoulder in December 2012. The examiner noted the Veteran reported left shoulder pain that was constant and tight. Upon physical examination, the examiner noted the Veteran’s left shoulder forward flexion to 180 degrees; and abduction to 130 degrees. The Veteran underwent another VA examination in October 2014. The examiner noted a diagnosis of rotator cuff tendonitis in both shoulders. The Veteran reported he had problems with both of his shoulders during basic training and throughout military service, and that they have gotten worse over the years, with popping, grinding, weakness, stiffness, and pain. Upon physical examination, the examiner noted the Veteran’s left shoulder forward flexion to 80 degrees; and abduction to be to 80 degrees. The Veteran underwent a final VA examination in October 2016. The examiner noted the Veteran reported bilateral shoulder pain, worsening over the last few years. He noted even holding his hands on the steering wheel of a car is painful. He also reported stiffness in the shoulders and pain that extends from the supraclavicular area to the posterior shoulder bilaterally. He takes Motrin but is not convinced that it helps. He has not had shoulder surgery, recent physical therapy or local steroid injections. He is receiving massage therapy but does not note much improvement. Upon physical examination, the examiner noted the Veteran’s left shoulder forward flexion to 135 degrees; and abduction to 65 degrees. In terms of functional impact, the examiner stated the Veteran works as a mail carrier for the US Post Office. His job involves carrying heavy loads, but he reports that he limits the distance he carries heavier packages. He would have difficulty performing a job requiring repetitive overhead activities and heavy lifting on a regular basis. VA treatment records from the Dallas VAMC are associated with the Veteran’s claims file. In summary, these records reflect the Veteran’s complaints, diagnosis, and treatment of shoulder pain over the years. Upon review of the relevant medical evidence, the Board finds that the Veteran’s symptoms are consistent with the 20 percent rating currently assigned for the Veteran’s left shoulder, based on the degree of flexion which was reported as no worse than 80 degrees when measured during the October 2014 VA examination, and the degree of abduction which was reported as no worse than 80 degrees when measured during the October 2014 examination. Here, to warrant a higher, 30 percent evaluation, the Veteran’s motion of the left shoulder would have to be limited to 25 degrees or less of flexion and/or abduction from the side. However, that level of limitation of motion of the left shoulder is simply not shown during the appellate period. Even considering the functional loss due to pain, the Veteran’s symptoms did not approximate limitation of motion of the arm to 25 degrees from the side. The Board has also considered whether a higher evaluation would be warranted under another potentially applicable diagnostic code. However, there is no medical evidence of ankylosis of the scapulohumeral articulation resulting in abduction to 60 degrees (Diagnostic Code 5200); or, impairment of the humerus (Diagnostic Code 5202). Thus, separate or higher ratings are not warranted under those Diagnostic Codes. Further, the Board finds that while the Veteran is competent to attest to the fact that he experiences pain in his shoulders, he is not competent to offer diagnoses of specific conditions or objective degrees of limitation of motion regarding his shoulders. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). As such, the Board finds that the medical evidence of record is the most probative evidence of the Veteran’s left shoulder disability. The preponderance of evidence weighs against the finding that a rating in excess of 20 percent is warranted for his left shoulder tendonitis for the period on appeal. As such, the Veteran’s claim for a higher rating must be denied. 3. Entitlement to an initial rating in excess of 10 percent for PTSD. PTSD is rated pursuant to the criteria of Diagnostic Code 9411 under the General Rating Formula for Mental Disorders. Under the General Rating Formula, a 10 percent rating is warranted for 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. A 30 percent rating is warranted when there is occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events). A 50 percent evaluation will be assigned with evidence of occupational and social impairment with reduced reliability and productivity due to such symptoms as: a 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. 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 ideations; 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 the veteran’s personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work like setting); inability to establish and maintain effective relationships. A 100 percent rating is warranted for total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform the 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. Here, the Veteran was granted service connection for an anxiety disorder and assigned a 10 percent rating in a September 2013 rating decision. The Veteran appealed the rating assigned, and in a November 2016 rating decision, the 10 percent rating was continued, but the Veteran’s mental health diagnosis was changed to PTSD. In October 2018, the Board remanded for additional development, to include a new VA examination to assess the current severity of the Veteran’s PTSD. It appears from the record that the Veteran cancelled the scheduled exam and as such, the Board will proceed based on the evidence of record. The Veteran underwent a VA examination in December 2012. The examiner diagnosed the Veteran with anxiety disorder, NOS (mixed anxiety and depression). The Veteran reported combat experience in the Army, and it was noted he received the Iraq Campaign Medal; Combat Action Badge; and Global War on Terrorism Medal. In terms of family/social history, the examiner noted the Veteran reported he was married for five months in 2008. He remarried in 2010 and the Veteran states his marriage is “terrible” and he plans to file for divorce. He has no children. He has one friend at Fort Hood, but mostly stays to himself. He was arrested for DUI, but the charges were dropped. The examiner stated the Veteran’s mental disorder symptoms are controlled by continuous medication and are not severe enough to interfere with occupational and social functioning. In May 2013, the Veteran was hospitalized for PTSD. Private treatment records from the Laurel Ridge Treatment Center reflect the Veteran was admitted May 7, 2013 and discharged May 16, 2013 for inpatient PTSD treatment upon referral from Fort Hood. The records note the Veteran endorsed hypervigilance, increased startle response, decreased concentration, irritability, avoidance, decreased sleep and nightmares. The Veteran also reported being easily triggered to believe that people in traffic are following him and he had an incident with the police when he was prepared to beat a fellow motorist with his cane. The Veteran denied suicidal ideation and homicidal ideation at the time of admission. It was noted he had not filled his prescription for Topamax or Baclofen since late February 2013. On May 15, 2013, the Veteran stated he feels like the environment and treatment is beneficial, but he is being “judged and threatened.” He was offered a transfer to another unit, but he felt he needed to be discharged. On May 16, 2013, the physician discussed the need for Veteran to stay, but he was not receptive. Arrangements were made for him to leave. He was to follow up with an Army substance abuse provider upon arrival to Fort Hood. The records reflect the Veteran was charged with DUI in 2014. An April 2017 mental health note reflects the Veteran is being supervised by the North Texas Veterans’ Regional Court. His pre-docket staffing and status hearing was held this day and the Veteran’s court team reviewed, discussed, and made appropriate recommendations regarding the Veteran’s participation in the court program. Veteran reported he recently got married. There are no concerns with him at this time as he has kept all his scheduled appointments and is being considered for graduation in the next few months. If Veteran is successful in completing his treatment plan goals, his case will be recommended for dismissal and his charges expunged. The Veteran underwent another VA examination in October 2016. The examiner provided a current diagnosis of PTSD. The examiner noted the Veteran provided a copy of medical records showing his admission at Laurel Ridge Treatment Center in May 2013. The examiner noted the Veteran did not complete treatment. The Veteran reported he had been married 2 times. His first marriage ended in divorce with no children. His second marriage ended in divorce reportedly because his wife didn’t feel safe because of the Veteran’s PTSD. The Veteran states he lives alone in a house in Reno, Texas, about 10 minutes from his parents. The Veteran states his last relationship ended about 4 months ago after being on and off for about 18 months. The Veteran reports no friends, stating, “I pretty much isolate myself.” The Veteran states he reads Facebook postings of interest and plays video games. As for employment, the Veteran states he currently works as a letter carrier for the US Postal Service and he denied any problems with work. For VA rating purposes, the examiner noted the Veteran had only 1 symptom: anxiety, although the examiner noted the Veteran has panic attacks. Lastly, the examiner stated the Veteran’s PTSD symptoms result in 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 medication. The Veteran underwent a psychological assessment at the Dallas VAMC in March 2017. Notes indicate this was a 4 hour evaluation by a clinical psychologist. The examiner noted the Veteran’s medical record includes the following diagnoses: chronic PTSD; depressive disorder; anxiety; and alcohol dependence. He has received medication management and therapy since August 2013. His primary concerns have been depression and anxiety. During this evaluation, the examiner noted the Veteran reported depressive symptoms including excessive sadness, self-criticism, psychomotor restlessness and agitation, insomnia, irritability, and poor concentration. Regarding PTSD symptoms, the examiner noted the Veteran reported a low level of intrusive memories of trauma, a high level of possible flashbacks (though this was unclear), strong physical reactivity, attempts to avoid triggers, strong negative beliefs about self and negative emotions (e.g., fear and anger), feeling social inhibited, hypervigilance, insomnia, and poor concentration. The examiner noted the Veteran has never been married, and at the time of the evaluation, he had a girlfriend of two years. The Veteran described his employment history as “terrible.” The examiner found it interesting that the Veteran specifically expressed a perception that he should be 100 percent service connected rather than 90 percent at the time of testing. He viewed himself as unemployable due to problems with chronic pain (neck, shoulder, migraines, ankles) and mental health (depression, anxiety, and forgetfulness). He reported previous jobs as a cashier at CVS (quit, because passed on for a promotion to shift supervisor); a forklift operator at Campbells Soup (terminated due to missing work); and, a forklift driver at WePac (terminated due to damaging goods while operating forklift). At the time of testing, he was working as a mail carrier at USPS (since June 2015) and noted difficulty managing time on his routes. The Veteran also reported a history of excessive alcohol use since his return from Iraq, which led to legal problems, including a DUI in 2014. At the time of the evaluation, he was under court-order by the Denton/Grayson Veteran’s Court (since December 2015) to participate in mental health/substance treatment. His participation has been generally adequate, though his insight has been poor regarding gaining and implementing coping skills from group therapy in particular. Nonetheless, at the time of the evaluation he has sustained almost two years of sobriety. Finally, the examiner stated the Veteran’s approach to the structured clinical interview and testing produced responses that appear to be of questionable validity. His responses indicate that he was reporting posttraumatic and depressive symptoms. Nonetheless, his response pattern was inconsistent during the clinical interview and across psychological tests. For instance, he reported high anxiety yet endorsed only a low level of anxiety symptoms on the BDI, yet a moderate to high level of PTSD symptoms on the PCL. Furthermore, his response pattern on the MMPI-2 was invalid. Although his responses were consistent across items, he endorsed an excessively high level of symptoms infrequent in the general population. His responses also indicated a high level of exaggeration of symptoms. Although there is evidence of secondary gain (a desire to be 100 percent service-connected), it must also be considered that this may be a cry for help and/or poor insight regarding his mental health symptoms. Overall, the results are indicative of only unspecified mood and unspecified anxiety disorder (trauma-related) at best. The examiner stated these diagnoses could not be clarified further due to his inconsistencies and atypical reporting of symptoms and ultimate invalidation of the primary testing instrument. VA treatment records from the Dallas VAMC are associated with the Veteran’s claims file. In summary, these records reflect the Veteran’s diagnosis and treatment of PTSD over the years, to include medication management and peer support group therapy. Most recently, a September 2017 record reflects the Veteran was trained on Alpha-Stim-AID. Alpha-Stim is an electrical modality providing an input in the range of 100 to 600 micro amps that is FDA approved for treatment of chronic pain, anxiety, insomnia and depression. It was indicated that steps of providing this treatment to the Veteran included interview/assessment of symptoms, trial of Alpha-Stim with direct supervision of therapist, training in complete patterns, frequencies and sequences backed up by written directions. Upon consideration of the medical and lay evidence in this case, including the opinions and findings of the December 2012 VA examiner, the Board finds that for the period prior to May 7, 2013, the Veteran’s symptoms were shown to more nearly approximate occupational and social impairment due to mild and transient symptoms. At that time, the examiner specifically stated the Veteran’s mental disorder symptoms were controlled by continuous medication and were not severe enough to interfere with occupational and social functioning, consistent with a 10 percent rating for the period prior to May 7, 2013. The Board does find, however, that the Veteran’s PTSD caused occupational and social impairment with reduced reliability and productivity, beginning with his in-patient hospitalization on May 7, 2013, and continuing thereafter. The Board notes that since then, the Veteran had impaired judgment as evidenced by his 2014 DUI; difficulty maintaining effective social relationships given his two marriages that resulted in divorce and breakup with a girlfriend of approximately 2 years; and other symptoms noted in his VA examinations such as panic attacks and disturbances of motivation and mood. The Board thus finds that the overall level of the Veteran’s symptomatology for the period in question (from May 7, 2013 and thereafter) most closely matches that considered in the 50 percent rating There is no evidence of symptoms of the type, extent, frequency, or severity indicative of those identified as warranting a 70 percent rating, such as 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; spatial disorientation; neglect of personal appearance and hygiene; and an inability to establish and maintain effective relationships. In so finding, the Board notes that the Veteran has consistently maintained employment at the US Postal Service, as documented on multiple occasions by treatment providers and examiners. Therefore, the Board finds that he does not have deficiencies in work relations. In addition, the Veteran did not report suicidal or homicidal ideation at any point during the appeal period. In conclusion, the Board finds that, for the period prior to May 7, 2013, the Veteran’s PTSD symptoms demonstrated occupational and social impairment due to mild and transient symptoms. For the period from May 7, 2013 and thereafter, his PTSD symptoms demonstrated occupational and social impairment with reduced reliability and productivity. Therefore, an initial rating of 10 percent, but no higher, for PTSD is warranted for the period prior to May 7, 2013. A rating of 50 percent, but no higher, for PTSD is warranted for the period from May 7, 2013 and thereafter. To this extent, the appeal is granted. K. MARENNA Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Jiggetts 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.