Citation Nr: 21026543 Decision Date: 05/03/21 Archive Date: 05/03/21 DOCKET NO. 15-22 453 DATE: May 3, 2021 ORDER Entitlement to service connection for hypertension, claimed as secondary to service-connected atherosclerosis and/or posttraumatic stress disorder (PTSD) is denied. Entitlement to an initial rating in excess of 70 percent for PTSD is denied. FINDINGS OF FACT 1. The preponderance of the evidence is against finding that the Veteran's hypertension had its onset in service or manifested to a compensable degree within the applicable presumptive period; or that there is continuity of symptomatology; or that the disability is otherwise etiologically related to in-service injury or disease, including herbicide exposure; or is caused or aggravated by service-connected atherosclerotic heart disease, status post myocardial infarction or posttraumatic stress disorder. 2. The evidence does not demonstrate that the service connected psychiatric disorder more nearly approximates total occupational and social impairment. CONCLUSIONS OF LAW 1. The criteria for service connection for hypertension, claimed as secondary to service-connected atherosclerosis and/or PTSD have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. 2. The criteria for an initial rating in excess of 70 percent for PTSD have not been met. 38 U.S.C. §§ 1155, 507(b); 38 C.F.R. §§ 4.3, 4.7, 4.130, Diagnostic Code 9411. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 1964 to March 1968. Service personnel record show that he served in the Republic of Vietnam from November 1966 to March 1968. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 2014 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO) which in pertinent part granted service connection for PTSD and assigned a 10 percent rating, effective September 26, 2012 (date of receipt of claim for service connection). A May 2015 rating decision increased the 10% rating for PTSD to 30% from the effective date of service connection. The Veteran was scheduled to appear at the Salt Lake City RO to have a videoconference hearing with a Veterans Law Judge, as he had requested. Although both he and his agent were notified of the time and date of the hearing by mail, both failed to appear and neither provided an explanation. Absent a motion for rescheduling, the hearing request is deemed withdrawn. See 38 C.F.R. § 20.704(d). A July 2019 Board decision denied a compensable initial rating for service-connected erectile dysfunction but remanded claims for service connection for hypertension and for tremors, as well as an increased rating for PTSD. A March 3, 2020 rating decision increased the 30% rating for PTSD to 70%, retroactively to the initial grant of service connection. In May 2020 the Board again remanded the claims for service connection for hypertension and for tremors, as well as a rating in excess of 70% for PTSD. A March 4, 2021 rating decision granted service connection for essential tremors and assigned an initial noncompensable evaluation effective February 28, 2013. This rating action was a full grant of this service connection claim remanded by the Board in July 2019 and May 2020. See Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997) (a grant of service connection extinguishes appeals before the Board). As such, there is no remaining allegation of error of fact or law for appellate consideration. Parkinson's Disease An October 2, 2014 VA outpatient treatment (VAOPT) shows that it had originally been thought that the Veteran's tremors were due to Parkinson's disease. The assessment was a history of right upper extremity tremors, not related to Parkinson's disease. A letter dated December 14, 2015, from the Veteran's then recognized agent stated that an attached letter from the Veteran "supports his contention of Parkinson's disease. Please resolve this claim in an expeditious manner." See Veterans Benefits Management System (VBMS) entry dated December 17, 2015. The July 2019 Board remand stated, at page 7, that "[t]he evidence of record shows that the Veteran is not diagnosed with Parkinson's disease. Notably, VA neurology treatment records dated in October 2016 indicated that the Veteran's [sic] is diagnosed with an essential tremor; the treatment provider stated that the Veteran 'does not yet have Parkinson's disease.' See VA treatment records dated October 2016. However, the Veteran and his representative have subsequently asserted that the Veteran's tremors are now indicative of Parkinson's disease. See the written argument of the Veteran's attorney dated March 2019; see also the Veteran's statement dated March 2019." An addendum opinion was obtained in February 2021, based on a review of the records, which stated that the Veteran was diagnosed with Parkinson's disease in 2012. He had prior initial diagnosis of benign essential tremors but it was later determined that he had Parkinson's disease. Since then he continued to be on medical treatment for Parkinson's disease, which was noted to be listed as associated with Agent Orange exposure. As noted, a March 4, 2021 rating decision granted service connection for essential tremors and assigned an initial noncompensable evaluation, effective February 28, 2013. The RO has not adjudicated a claim for service connection for Parkinson's disease. The Veteran is advised that the statements of record do not meet the standards imposed, effective March 24, 2015, of an intent to file (38 C.F.R. § 3.155(b)) or those of a complete claim under 38 C.F.R. § 3.155(a). The RO should notify the Veteran as to the procedures required under 38 C.F.R. § 3.155 for filing a claim for VA benefits, i.e., that a claim for benefits must be submitted on a VA prescribed application form. TDIU Rating On November 17, 2017, the Veteran's Application for Increased Compensation Based on Unemployability, VA Form 21-8940, was received. Essentially, this set forth a claim for a total disability rating based on unemployability due to service-connected disabilities (commonly called a TDIU rating). However, under 38 C.F.R. § 4.16(a) a TDIU rating may not be assigned when a veteran is in receipt of a 100% schedular rating. Here, a February 21, 2018 rating granted a 100% schedular rating for service-connected atherosclerosis with status post (SP) myocardial infarction (MI), effective November 17, 2017, which has remained in effect since then (and is also the date of receipt of the TDIU claim). Moreover, the Veteran is in receipt of special monthly compensation under 38 U.S.C. § 1114(s) and 38 C.F.R. § 3.350(i) on account of atherosclerosis with SP MI rated 100% and additional service-connected disabilities independently ratable at 60% percent since November 17, 2017. Accordingly, the claim for a TDIU rating is moot. Lastly, pursuant to the July 2019 and May 2020 Board remands records of Group Health have been obtained. Those remands also requested that records of a Vet Center be obtained, and the RO attempt several times to obtain such records but was unsuccessful. Those remands also requested VA examination and etiology opinion as to the claimed hypertension, and this was done. Thus, there has been substantial compliance with the prior Board remands. Stegall v. West, 11 Vet. App. 268, 271 (1998). Entitlement to service connection for hypertension, claimed as secondary to service-connected atherosclerosis and/or PTSD It is shown that the Veteran now has hypertension and he contends that it is of service origin or related to inservice herbicide exposure; or, alternatively, is associated with his service connected atherosclerotic heart disease, SP MI, or PTSD. As an initial matter, service personnel records show that he served in the Republic of Vietnam from November 1966 to March 1968. Thus, his inservice exposure to herbicides is conceded. The Board concludes that while the Veteran was exposed to herbicides during service, and is service connected for atherosclerotic heart disease, SP MI, and PTSD, the preponderance of the evidence is against finding that his hypertension had its onset in service or manifested to a compensable degree within the applicable presumptive period; or that there is continuity of symptomatology; or that the disability is otherwise etiologically related to in-service injury or disease, to include in-service herbicide exposure; or is associated with his service connected for atherosclerotic heart disease, SP MI, or PTSD. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137, 5107(b); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. Service connection may be granted for any disease diagnosed after discharge, when the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Establishing service connection generally requires (1) evidence of a current disability; (2) evidence of in-service incurrence or aggravation of a disease or injury; and (3) evidence of a nexus between the claimed in-service disease or injury and the present disability. Shedden v. Principi. 381 F.3d 1163, 1167 (Fed. Cir. 2004); see Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd per curiam, 78 F.3d 604 (Fed. Cir. 1996) (table); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a), (d). For recognized chronic diseases, listed at 38 C.F.R. § 3.309(a), and including hypertension, service incurrence or aggravation may be established if manifested to a compensable degree within one year following service under 38 U.S.C. §§ 1110, 1112, 1131, 1137 and 38 C.F.R. § 3.307(a)(3), 3.309(a) or under 38 C.F.R. § 3.303(b) by demonstrating continuity of symptomatology. See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Certain diseases have been determined to be associated with the use of herbicide agents and VA regulations identify those disease that are presumptively associated with herbicide agent exposure. 38 C.F.R. § 3.309(e). Ischemic heart (such as the Veteran's service-connected atherosclerotic heart disease) is a disease identified as presumptively associated with herbicide agent exposure. 38 U.S.C. § 1116; 38 C.F.R. § 3.309(e). However, hypertension is not a disease identified as presumptively associated with herbicide agent exposure. 38 U.S.C. § 1116; 38 C.F.R. § 3.309(e). Note 2 to 38 C.F.R. § 3.309(e) specifically provides that hypertension is not a form of ischemic heart disease Service connection will be granted on a secondary basis for disability that is proximately due to or the result of, or permanently aggravated by, an already service-connected condition. 38 C.F.R. § 3.310(a) and (b). This requires (1) evidence of a current disability; (2) a service-connected disability; and (3) evidence establishing a nexus between the service-connected disability and the claimed disability. Wallin v. West, 11 Vet. App. 509, 512 (1998). Reasonable doubt will be favorably resolved but if the preponderance of the evidence is against the claim, the benefit of the doubt rule is not applicable. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Ortiz v. Principi, 274 F.3d 1361, 1365-66 (Fed. Cir. 2001). The available STRs consist only of the Veteran's separation examination and an adjunct Report of Medical History. Thus, his service treatment records (STRs) are incomplete. See entry into the Veterans Benefits Management System (VBMS) of January 24, 1971. Where the STRs are incomplete, the obligation to explain findings and conclusions and to carefully consider the benefit-of-the-doubt rule is heightened. O'Hare v. Derwinski, 1 Vet. App. 365, 367 (1991). But this does not lower threshold for an allowance of a claim, for example altering the standard for resolving doubt. In other words, the legal standard for proving a claim is not lowered; rather, the Board obligation to discuss and evaluate evidence is heightened. Russo v. Brown, 9 Vet. App. 46 (1996). Moreover, the absence of some of the STRs does not create an adverse-presumption rule. Cromer v. Nicholson, 19 Vet. App. 215 (2005). In the Veteran's March 23, 2014 Notice of Disagreement (NOD) he reported that he was treated continuously for hypertension since he got home from Vietnam. To the extent that he implies that he had hypertension during his active service, the report of the separation examination shows that his blood pressure was 118/86. In an adjunct Report of Medical History he reported not having or having had high or low blood pressure. As to continuous postservice treatment, a Hypertension Disability Benefits Questionnaires (DBQs) in July 30, 2014, shows that he was diagnosed as having hypertension in the 1980s, which is more than a decade after his military service. Moreover, a more recent Hypertension DBQ shows that, while the record indicated he was diagnosed with hypertension in the 1980s, the Veteran actually reported that he could not remember when he was diagnosed with hypertension. Consequently, the Board finds that his statement of continuous postservice treatment for hypertension is lacking in probative value. Continuity of symptomatology, as opposed to actual treatment, may be basis for demonstrating that a chronic disease is of service origin. However, the Veteran is not competent to say that his blood pressure was elevated to the level that meets VA standards for hypertension which is required to establish a claim for service connection for hypertension. For VA purposes, hypertension means that the diastolic pressure is predominantly 90 or greater, and isolated systolic hypertension means that the systolic pressure is predominantly 160 or greater with a diastolic pressure of less than 90. See 38 C.F.R. § 4.104, Diagnostic Code 7101. The presence of hypertension is made through measurements of blood pressure and the Veteran's lay opinion is not predicated on any testing that meets the VA requirements. The presence of disability due to hypertension is not otherwise susceptible to lay observation. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009) and Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). Therefore, the appellant's medical opinion has no probative value. Moreover, it must be noted that a report of VA examination in February 1971, for another disorder, shows that the Veteran's blood pressure was 112/70. This is well within normal limits. Additionally, the Veteran has not submitted any medical evidence that his hypertension is of service origin. Similarly, the Veteran has not offered any evidence that his hypertension is due to his conceded inservice herbicide exposure. In this regard, an addendum VA medical opinion in February 2021 noted that hypertension was not a disease listed in VA regulations as being presumptively due to herbicide exposure. This alone is not sufficient to deny the claim. See Polovick v. Shinseki, 23 Vet. App. 48, 55 (2009). However, that same medical opinion also provided a rationale that, in essence, the Veteran's hypertension began due to the aging process, noting that as an individual age, the chances of acquiring hypertension increased, and hypertension was the most prevalent condition seen globally as a person became older. Consequently, the Board finds that a basis for service connection for hypertension as being due to inservice herbicide exposure is not established. With respect to any relationship between the Veteran's service connected atherosclerotic heart disease and his hypertension a July 30, 2014, Hypertension Disability Benefits Questionnaire (DBQ) reflects that the Veteran's claim file was reviewed and, noting that hypertension was diagnosed in the 1980s and that his blood pressure was actually lower after his first heart attack in the 1990s, it was opined that his hypertension was less likely as not proximately the result of his heart disease, and the rationale was that he had developed hypertension prior to his myocardial infarction and, so, hypertension could not be the result of his heart disease. A February 13, 2020 Hypertension DBQ also reflects that the Veteran was examined and his records reviewed. The examiner opined that the hypertension was less likely than not (less than 50% probability) incurred in or caused by the claimed in-service injury, event or illness and was not due to atherosclerosis because the hypertension preceded his diagnosis of atherosclerosis. Also, hypertension was a risk factor for developing atherosclerosis, not the other way around (atherosclerosis did not lead to hypertension). In opining as to whether hypertension was at least as likely as not aggravated beyond its natural progression by his/her service connected atherosclerosis it was stated that the contrary was true, i.e., treatment of his heart disease actually had resulted in lowering of his blood pressure. There are no contrary medical opinions and, so, the Board concludes that the preponderance of the evidence weighs against finding that hypertension was caused or aggravated by the service connected atherosclerosis. As to any nexus between hypertension and service connected PTSD, including any other diagnosed psychiatric disorders which are part of the PTSD (as discussed later herein), in March 2019 the Veteran submitted an article entitled "Hypertension in Relation to [PTSD] and Depression in the US National Comorbidity Survey." That article indicates that depression as well as PTSD were associated with a higher risk for the development of cardiovascular disease (CVD), including hypertension. However, "[a] mutual relationship or some degree of correspondence that is not based on causation or aggravation is not sufficient to meet the requirements of [38 C.F.R.] § 3.310." Harvey v. Shulkin, No. 16-1515, slip op. at 13 (U.S. Vet.App. (Feb. 7, 2018) (panel decision). A February 13, 2020 Hypertension DBQ reflects that the Veteran was examined and his records reviewed. It was opined that the Veteran's service connected psychiatric disorder had not caused or aggravated his hypertension. The rationale was that while PTSD could cause elevation in blood pressure, this was transient, not chronic. There are no contrary medical opinions and, so, the Board concludes that the preponderance of the evidence weighs against finding that hypertension was caused or aggravated by the service connected PTSD. Lastly, although it has not been contended that the Veteran's service connected nephrosclerosis is related to his hypertension, a February 6, 2018 Kidney Conditions DBQ reflects that the Veteran had a diagnosis of nephrosclerosis, the date of onset of which was 4 12 to 5 years earlier. Since the hypertension preceded the nephrosclerosis it was concluded that he did not have "hypertension and/or heart disease due to renal dysfunction or caused by any kidney condition." In sum, the Board concludes that the preponderance of the evidence establishes the Veteran's hypertension first manifested many years after service and is unrelated to his conceded inservice herbicide exposure and his service connected atherosclerosis, PTSD, and nephrosclerosis. Thus, there is no doubt to be resolved. Entitlement to an initial rating in excess of 70 percent for PTSD Disability evaluations are determined by the application of the VA Schedule for Rating Disabilities (Rating Schedule). 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and their residual conditions in civil occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Any reasonable doubt regarding the degree of disability will be resolved in favor of the claimant. 38 C.F.R. § 4.3. If two evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that evaluation; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. A disability may require re-evaluation in accordance with changes in a veteran's condition. It is thus essential, in determining the level of current impairment, that the disability be considered in the context of the entire recorded history. 38 C.F.R. § 4.1. The question for the Board is whether the severity, frequency, and duration of psychiatric symptoms more nearly reflect total occupational and social impairment. The Board concludes that the preponderance of the evidence is against the claim for increase. During the appeal, the evidence reflects that PTSD was not more nearly manifested by total occupational and social impairment therefrom, due to the severity, frequency, and duration of psychiatric symptoms. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.123, 4.130 Diagnostic Code 9411. Under the General Formula for Mental Disorders (General Formula), the Board must conduct a "holistic analysis" that considers all associated symptoms, regardless of whether they are listed as criteria. Bankhead v. Shulkin, 29 Vet. App. 10, 22 (2017); 38 C.F.R. § 4.130. The Board must determine whether unlisted symptoms are similar in severity, frequency, and duration to the listed symptoms associated with specific disability percentages. Then, the Board must determine whether the associated symptoms, both listed and unlisted, caused the level of impairment required for a higher disability rating. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 114-118 (Fed. Cir. 2013); Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). The Veteran's mental disorder is rated at 70 percent since September 26, 2012, under Diagnostic Code 9411 which provides for a 10% rating if controlled by medication. Thus, the holdings in Jones v. Shinseki, 26 Vet. App. 56, 63 (2012) and McCarroll v. McDonald, 28 Vet. App. 267, 271 (2016) (en banc) (that a higher rating may not be denied on the basis of relief provided by medication when those effects are not specifically contemplated by the rating criteria) are inapplicable. Ratings for 30% and 50% contemplate additional rating criteria. A 70 percent rating is assigned when symptoms such as suicidal ideation; obsessional rituals which interfere with routine activities; intermittently illogical, obscure, or irrelevant speech; 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); or inability to establish and maintain effective relationships cause occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. A 100 percent rating is assigned when symptoms such 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; or memory loss for names of close relatives, own occupation or own name cause total occupational and social impairment. VA treatment records, VA examinations and private treatment records show that the Veteran's PTSD has been manifested by symptoms associated with a 30 percent rating (e.g., chronic sleep impairment and mild memory loss), 50 percent rating (e.g., depressed mood, impairment of short and long-term memory, disturbances of motivation and mood, anxiety, suspiciousness, and difficulty in establishing and maintaining effective work and social relationships) and symptoms associated with a 70 percent rating (e.g., difficulty in establishing and maintaining effective work and social relationships and difficulty in adapting to stressful circumstances, including work or worklike setting). He also had symptoms that are not listed with a specific rating, such as hypervigilance, irritability, anger, isolation, and avoidance of crowds. See statement of the Veteran's wife received in January 2013; treatment records of Group Health Cooperative of October 22, 2010, September 2012, and January 2013, and VA outpatient treatment (VAOPT) record of September 17, 20912. The record does not reflect continued regular treatment, but does show occasional mental health treatment and group therapy sessions. The Board will consider, for rating purposes, all of the Veteran's psychiatric symptoms and impairment from any psychiatric disability(ies) because while the 2014 VA examination found that his only psychiatric disorder was PTSD, a 2014 Vet Center report indicates that he also has a generalized anxiety disorder and together they produced "moderate plus" impairment. Additionally, the most recent VA psychiatric examination stated that his co-existing major depressive disorder was a progression of depression associated with PTSD. The available medical and lay evidence overall does not demonstrate the level of impairment associated with a 100 percent rating. As noted above, the Veteran's reported symptoms were either contemplated by or more consistent with a 70 percent rating, or even less, and the Board also finds this even with the clinical findings demonstrates that the overall level of impairment more closely approximates the 70 percent rating. On VA psychiatric examination in July 2014 the Veteran's level of social and occupational impairment from psychiatric symptoms was not severe enough to interfere with occupational and social functioning. He had a good relationship with his wife but his relationship with his son was strained due to financial concerns. He had been employed from 1968 until he retired in 2000, with only occasional work since then. He had had flashbacks and preferred to be alone. He had had some counseling since 2012 and had taken medication since early 2014. He reported having difficulty concentrating and being forgetful. He had been unable to control his temper, but medication decreased his irritability and his outbursts. A February 2019 report of a psychological evaluation by a private psychologist reflects that the Veteran had retired after 37 12 years of employment. He reported having had satisfactory working relationships with coworkers and supervisors. He had no history of inpatient psychiatric treatment. At the February 2020 VA psychiatric examination the Veteran's symptoms were deemed productive of occupational and social impairment with, which corresponds with a 70 percent rating. In this regard, repeated examinations have reflected appropriate behavior and good hygiene. Furthermore, his symptoms do not affect his ability to function independently, appropriately, and effectively; and he did not seek continuous mental health services to treat his symptoms. Further, he sought mental health treatment intermittently during the appeal period and did not seek to pursue individual therapy sessions. The Veteran has never been shown to have 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; or memory loss for names of close relatives, own occupation or own name. The evidence shows that the Veteran has maintained a steady relationship with his wife; has been fully oriented and cooperative with examiners; has had a no impairment of his speech or thought processes and, while he recently related a history of suicidal ideation, he has not been a persistent danger of hurting himself or others. Similarly, the evidentiary record shows that he has not had delusions, hallucinations, or any significant impairment of his memory. And all this is consistent with the 70% rating or even less. As such, the medical and lay evidence of record does not reflect that he is precluded from functioning adequately both mentally and behaviorally on a daily basis, or that his level of psychiatric is such as to cause total occupational and social impairment. In fact, there is no evidence that he has the severe degree of memory impairment contemplated by a 100% rating and, likewise, no evidence of psychiatric symptoms productive of gross impairment of cognitive functions and behavior or the preclusion of simple activities of daily living (such as maintaining minimal personal hygiene; or a level of symptoms that reflect any loss of touch with reality. The Board acknowledges the Veteran's social isolation, feeling restless, intrusive thoughts of trauma, feelings of detachment from others, difficulty with anger management, and avoidance of external reminders. However, these symptoms are fully contemplated by the currently assigned 70 percent rating as discussed above and are not shown by either the lay or medical evidence to more nearly reflect the criteria for a 100 percent rating. Moreover, Veteran's hypervigilance is similar to anxiety, which is contemplated by the 30 percent rating. His isolation and avoidance of crowds is similar to depression, which is also contemplated by the 30 percent rating as is any sleep impairment. The Board accepts that the Veteran believes his symptoms warrant a rating in excess of 70 percent. However, whether a disability meets the schedular criteria for the assignment of a higher evaluation is a factual determination by the Board based on the Veteran's complaints coupled with the medical evidence. Both the lay and medical evidence are probative in this case. Although the Veteran may believe that he meets the criteria for the next higher disability rating, his complaints along with the medical findings do not meet the schedular requirements for a higher evaluation than now assigned, as explained and discussed above. In summary, the severity, frequency, and/or duration of symptoms, individually or collectively, shown by the record do not more nearly reflect the level of impairment contemplated by the schedular criteria for an evaluation in excess of 70 percent for PTSD, which requires total occupational and social impairment. Accordingly, the claim is denied. As the evidence of record is not roughly in equipoise, there is no doubt to resolve. 38 U.S.C. § 5107(b). Saudiee Brown Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Fussell, 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.