Citation Nr: 21028241 Decision Date: 05/10/21 Archive Date: 05/10/21 DOCKET NO. 14-35 955 DATE: May 10, 2021 ORDER Entitlement to an initial rating in excess of 50 percent for service-connected posttraumatic stress disorder (PTSD), from June 21, 2010 to April 29, 2019, is denied. Entitlement to a 70 percent rating from April 30, 2019, but no higher, for service-connected PTSD is granted. FINDINGS OF FACT 1. For the period on appeal prior to April 29, 2019, the Veteran's service-connected PTSD was more nearly approximated by occupational and social impairment with reduced reliability and productivity. 2. From April 30, 2019, the Veteran's service-connected PTSD was more nearly approximated by occupational and social impairment, with deficiencies in most areas, but not by total occupational and social impairment. CONCLUSIONS OF LAW 1. The criteria for an initial rating in excess of 50 percent for service-connected PTSD, from June 21, 2010 to April 29, 2019, have not been satisfied. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321, 4.1, 4.2, 4.3, 4.7, 4.10, Diagnostic Code 9411. 2. The criteria for a 70 percent rating from April 30, 2019, but no higher, for service-connected PTSD have been satisfied. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321, 4.1, 4.2, 4.3, 4.7, 4.10, Diagnostic Code 9411. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from February 2002 to June 2002 and from December 2003 to March 2005, to include service in Southwest Asia. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a March 2011 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). In July 2019, the Board granted a rating of 50 percent prior to April 30, 2019 and denied a rating in excess of 50 percent from April 30, 2019 for the Veteran's service-connected PTSD. The Veteran appealed the Board's decision denying a rating in excess of 50 percent for his service-connected PTSD to the United States Court of Appeals for Veterans Claims (Court), which, in April 2020, granted a Joint Motion for Remand (JMR). The Court's order vacated the Board's July 2019 decision and remanded the matter to the Board consistent with the terms of the joint motion. The Veteran previously requested a hearing on his October 2014 VA Form 9; however, the Veteran withdrew his hearing request in March 2018. Increased Ratings Disability ratings are determined by applying a schedule of ratings that is based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R., Part 4. Each disability must be viewed in relation to its history and the limitation of activity imposed by the disabling condition should be emphasized. 38 C.F.R. § 4.1. Examination reports are to be interpreted in light of the whole recorded history, and each disability must be considered from the point of view of the appellant working or seeking work. 38 C.F.R. § 4.2. Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is to be assigned. 38 C.F.R. § 4.7. The Veteran's entire history is to be considered when making disability evaluations. See generally 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). With the initial rating assigned with the award of service connection for a disability, "staged" ratings to reflect distinct periods when different levels of impairment were shown are for consideration. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Where entitlement to compensation has already been established and increase in disability is at issue, the present level of disability is of primary concern. See Francisco v. Brown, 7 Vet. App. 55 (1994). Under Diagnostic Code 9411, PTSD, a 50 percent rating is warranted if there is occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships. 38 C.F.R. § 4.130, Diagnostic Code 9411. 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 worklike setting); inability to establish and maintain effective relationships. 38 C.F.R. § 4.130, Diagnostic Code 9411. A 100 percent evaluation 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 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. 38 C.F.R. § 4.130, Diagnostic Codes 9411. The list of symptoms under the rating criteria are meant to be examples of symptoms that would warrant the evaluation but are not meant to be exhaustive. The Board need not find all or even some of the symptoms to award a specific evaluation. Mauerhan v. Principi, 16 Vet. App. 436, 442-3 (2002). On the other hand, if the evidence shows that a veteran suffers symptoms or effects that cause occupational or social impairment equivalent to what would be caused by the symptoms listed in the diagnostic code, the appropriate equivalent rating will be assigned. Mauerhan, 16 Vet. App. at 443. The United States Court of Appeals for the Federal Circuit (Federal Circuit) has embraced the Mauerhan Court's interpretation of the criteria for rating psychiatric disabilities. Sellers v. Principi, 372 F.3d 1318, 1326 (Fed. Cir. 2004). The U.S. Court of Appeals for the Federal Circuit (Federal Circuit) provided additional guidance in rating psychiatric disability. See Vazquez-Claudio v. Shinseki, 713 F.3d 112 (Fed. Cir. 2013). Specifically, the Federal Circuit emphasized that the list of symptoms under a given rating is a non-exhaustive list, as indicated by the words "such as" that precede each list of symptoms. Id. at 2. It held that a veteran may only qualify for a given disability rating under § 4.130 by demonstrating the particular symptoms associated with that percentage or others of similar severity, frequency, and duration. Id. at 4. Other language in the decision indicates that the phrase "others of similar severity, frequency, and duration," can be thought of as symptoms of like kind to those listed in the regulation for a given disability rating. Id. at 2. 1. Prior to April 30, 2019. The Veteran and his representative contend that the Veteran should be rated at 70 percent from June 21, 2010 for his service-connected PTSD. A June 2010 VA psychiatry note documents the Veteran's reports of increased nightmares and night sweats for the past couple of weeks following a friend's death in Afghanistan. The note also documented that the Veteran's mood was anxious and that the Veteran consumed alcohol daily but that a suicide screen was negative. Lastly, the June 2010 record noted that with school out for the summer, the Veteran was working on his farm and that the Veteran planned to apply for a principal position for the following year. An August 2010 VA psychiatry record notes that the Veteran was hired as an assistant principal at a new school but that he was dealing with multiple staff complaints. The Veteran also reported experiencing a nightmare after shooting the gun he carried in Iraq. He reported thinking about combat memories of Iraq much of the time. He also reported feelings of anger and worsening memory for names. The Veteran had decreased his alcohol use and a suicide screening was again negative. In an August 2010 statement, the Veteran's wife explained that since returning from his deployment the Veteran was quieter, not outgoing, argued with her, slept poorly, talked and fought in his sleep, woke startled, isolated, and had a short-tempered, distant attitude. In an August 2010 statement in support of his claim the Veteran stated that he had anger issues since returning from Iraq and had difficulty with social relationships. He also explained that he had nightmares and could not sleep without medication or alcohol. The Veteran further explained that he started drinking heavily to get an 'I don't care what happens to me' feeling. He lacked motivation, had a hard time respecting authority, had suicidal thoughts, had difficulty with his marriage, and avoided leaving his home. The Veteran was afforded a VA examination in February 2011. Post-military the Veteran reported completing his bachelor's degree followed by his master's degree plus 30 hours in education. The VA examiner noted that the Veteran was in his first year as an assistant principal at an elementary school and that the Veteran had not lost any work time in the past 12 months due to his psychiatric disability. The Veteran reported symptoms of insomnia and nightmares and that he only slept 4 to 6 hours per night. The Veteran also reported flashbacks, forgetfulness for names of acquaintances and friends that he had known for years, reduced attention and concentration during the day, daytime fatigue, increased irritability, reduced frustration tolerance, and anger outbursts. Other symptoms included social withdrawal, social avoidance, reduced patience and tolerance for others, marked sleep disruption, emotional detachment, reduced motivation to engage in activities he previously enjoyed, reduced attention, concentration, and mild memory disturbance, depression, inability to relax, feelings of guilt and impending punishment, recurrent and intrusive thoughts and recollections about his traumatic experiences, and heightened physiological arousal. The Veteran's symptoms were described as ongoing, moderate to severe and experienced daily/nightly. The Veteran reported that a good friend had been recently killed overseas and that seemed to have increased his symptoms. The Veteran reported that his relationship with his wife was good, that he had regular contact with his father, but that his relationship with his mother was strained since he returned from Iraq. He also reported that he had some contact with buddies from service but rarely had contact with friends from the past. He denied any activities or leisure pursuits but reported that he did work on his farm. The Veteran also reported a suicide attempt immediately after returning from Iraq. The VA examiner noted, "The Veteran is abusing alcohol in order to induce physiological relaxation and sleep. He describes consistent, daily use of alcohol for these purposes. His symptoms of PTSD are the impetus for his use of alcohol." Lastly, the VA examiner noted that the Veteran appeared guarded and somewhat unwilling to admit the severity of his issues during the examination. In a September 2014 statement in support of his claim the Veteran stated that since returning home from Iraq he had nightmares, jitters, panic attacks, dreams of stressors, and night sweats; avoided crowds; avoided social events; had few friends except buddies from service; isolated; had trouble with work and home relationships; was angry; had spouts of rage and punched holes in walls of his home; lacked motivation; struggled with depression; had a distant relationship with his kids; and wondered if he should be here. The Veteran also explained that he had sleep impairment and took over the counter sleep aids and consumed alcohol to sleep. The Veteran also reported nightmares, flashbacks, difficulty falling back to sleep, waking drenched in sweat, and having attacked his wife once in her sleep because he thought she was an enemy. The Veteran was afforded another VA examination in December 2015. The VA examiner again noted a diagnosis of PTSD. The VA examiner noted that the Veteran lived with his wife of 14 years and their twin sons. The Veteran reported that his marriage was 'pretty good' but that his wife nagged like a 'typical' wife and that he thought his marriage was 'normal'. He reported getting along well with his sons and enjoyed spending time with them. The Veteran also reported a very good relationship with his father and that he saw him often. The Veteran had two close friends that he served with and saw them several times a month. The Veteran reported that he enjoyed farming his 150-acre cattle farm and riding dirt bikes. The Veteran also worked as a principal at an elementary which he stated he enjoyed. He described a good relationship with his staff since he was 'laid back and mild-mannered.' He denied having any issues at the school. The Veteran also reported that he kept himself very busy with little downtime between the farm and his job as a principal so that he would not have time to think about his deployment. The Veteran reported that he was more reserved and mellow mannered than he used to be and that although he would raise his voice, he would walk away when angry. The Veteran also reported that he felt depressed 2 to 3 days a week and often thought about how to stop his distressing memories. The Veteran denied any suicidal ideation but stated that some days he feels that he has no value. The Veteran reported taking a couple of shots of liquor every night in order to relax and sleep. The Veteran reported that he thought about his deployment daily and felt that he could "never really get away from it". The Veteran's symptoms included depressed mood, anxiety, suspiciousness, chronic sleep impairment, flattened affect, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships. The VA examiner noted: "Currently the Veteran's PTSD appears to be having a moderate impact on him. Although Veteran reports doing very well in his jobs as a principal and farmer it is clear that he uses his jobs in order to avoid thinking about his deployment." The VA examiner concluded that the Veteran's PTSD was manifested by occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care and conversation. Finally, a June 2017 VA treatment record notes that depression and PTSD screenings were both negative. Based on the foregoing, the Board finds that for the period on appeal prior to April 29, 2019, the Veteran's PTSD more closely approximated the criteria for a 50 percent rating and was manifested by occupational and social impairment with reduced reliability and productivity. The Veteran exhibited impaired short- and long-term memory with his forgetfulness for names of acquaintances longtime friends which is contemplated by the criteria for a 50 percent rating. See June 2010 VA treatment record and February 2011 VA examiner's report. The Veteran also exhibited disturbances in motivation and mood due to outbursts of anger and depressed feelings. See February 2011 and December 2015 VA examiner's reports. However, the Veteran reported in December 2015 that his mood had mellowed and that although he would still raise his voice, he would walk away from conflicts. The Veteran also reported good relationships at work because his staff viewed him as 'laid back and mild-mannered.' Moreover, the Veteran was even promoted from assistant principal to a principal position during this period. On the other hand, the Veteran regularly reported arguments with his wife and frustration with his children. The Veteran also reported isolating and having only two close military friends. The Board notes, however, that difficulty in establishing and maintaining effective work and social relationships is also contemplated by the criteria for a 50 percent rating. A higher 70 percent rating contemplates some symptoms that the Veteran did not exhibit 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 difficulty in adapting to stressful circumstances (including work or a worklike setting). The Board notes that a higher, 70 percent rating also contemplated impaired impulse control (such as unprovoked irritability with periods of violence). The Board acknowledges that Veteran did reports spouts of rage and punching holes in walls of his home. See September 2014 Statement. The Veteran also reported trouble making friends stating that he only had two friends, problems with his marriage, a poor relationship with his mother, and frustration with his children. The Board finds that although the Veteran had avoidance and isolation tendencies and reported some strained relationships, he did not have an inability to establish and maintain effective relationships as contemplated by the criteria for a 70 percent rating. To the contrary, the Veteran remained married for over a decade, thought his marriage was normal, had a close relationship with his father, remained close to two friends from service and saw them a couple times a month, was liked by his school staff, and was promoted to a principal position. Lastly, the Board acknowledges the Veteran's August 2010 statement asserting that he had suicidal thoughts. The Board also acknowledges the Veteran's September 2014 statement in which he stated that he wondered if she should still be here. The Board finds these thoughts to be no more than passive suicidal ideation. Both passive and active suicidal ideation are comprised of thoughts: passive suicidal ideation entails thoughts such as wishing that you were dead, while active suicidal ideation entails thoughts of self-directed violence and death. Bankhead v. Shulkin, 29 Vet. App. 10, 20 (2017). When evaluating psychiatric disabilities, the Board considers the frequency, severity, and duration of suicidal ideations and the impact on the Veteran's life, rather than limiting consideration to the intention to act. Here, no caregivers or the VA examiner has determined that he had plans or committed any overt acts, and he specifically denied thoughts to harm himself or others. Importantly, they have not found this symptom has inhibited his ability to function. Instead, he had suicidal ideation described as intermittent, and without plan or intent. The evidence does not show the Veteran's suicidal thoughts or ideation affected his functioning; that is, interfering with job performance, activities of daily living, routine activities, etc. In sum, while the Veteran's symptoms include occasional passive suicidal thoughts, this symptom has not affected his ability to function independently or created a deficiency in most areas of the Veteran's life for the purposes of the next higher, 70 percent rating under the General Rating Formula for Mental Disorders. Moreover, even if the suicidal thoughts do represent suicidal ideation, the December 2015 VA examiner considered these thoughts along with all the other symptomatology and still found that overall the disability was productive of occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care and conversation. Not only did this opinion include consideration of the Veteran's reports of passive suicidal ideation, but this particular level of occupational and social impairment is contemplated by a lower, 30 percent rating under the rating criteria, and no medical professional has described a level of impairment greater than that found by the VA examiner. Accordingly, the Board finds that for the periods from June 21, 2010 to April 29, 2019, the currently assigned 50 percent rating most closely approximates the Veteran's symptoms caused by his service-connected PTSD. 2. From April 30, 2019. The Veteran was afforded a VA examination in April 2019. The VA examiner again noted a diagnosis of PTSD. The Veteran symptoms included depressed mood, anxiety, suspiciousness, chronic sleep impairment, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, difficulty in adapting to stressful circumstances including work or a worklike setting, and suicidal ideation. The Veteran reported that he remained married to his wife of 15 years and that they had 2 sets of twins. The Veteran also reported that he and his wife bickered and fought all the time but that he believed that it was "typical marriage stuff." The Veteran stated that he got along well with his children and that they were his "pride and joy." The Veteran also reported that because of his desire to avoid people, he limited his children's ability to engage in activities, such as organized sports, despite their desire to do so. He also reported that he often lacked patience with his children and was easily frustrated. The Veteran reported enjoying working on his farm, riding dirt bikes, and camping. Other than his family, the Veteran was distant toward people. The Veteran reported that he worked as a principal at an elementary school for the past 7 years and continued to do so, however, he expressed a desire to quit and stated, "it's too much." He explained that had a hard time dealing with people, was easily frustrated, and did not like the new leadership at work. The Veteran also worked on his 160-acre farm and grew corn and soybeans. The Veteran reported that he thought of his deployment often and that it was a part of everyday life. He also reported monthly nightmares and frequently waking in night sweats. He kept himself busy to avoid thinking about his deployment. He also drank 2 cases of beer per week. The Veteran reported the if he drank 7 or 8 beers a night, he could sleep for 8 hours but still not feel rested. However, he limited his drinking on work nights in fear of being fired because someone at work reported that his breath smelled of alcohol. The Veteran reported suicidal thoughts and a past attempt but denied current intent or plans because of his children. The VA examiner determined that the Veteran's PTSD had a moderate impact on his overall social and occupational functioning. The VA examiner concluded that the Veteran's PTSD was manifested by occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care and conversation. In a January 2021 statement in support of his claim the Veteran referenced a past suicide attempt and stated that he often feels that his family would be better off without him. The Veteran's also explained that his PTSD caused strain on his marriage and caused him to engage in screaming matches, struggle with anger, feel on edge, have poor sleep, struggle with motivation, struggle with names of people he's known for years, have outbursts, avoid crowds, and be hypervigilant. He also explained that the elementary school that he worked at asked him to step back from his role as principal at one point after several grievances were filed against him by teachers and after he had multiple yelling matches with irate teachers but that he was back in his role as principal. The Veteran underwent a private examination via telephone conference in March 2021. The March 2021 private examiner noted that the Veteran had been twice married, had four kids, obtained a master's degree, and no history of arrest or inpatient psychiatric hospitalization but that the Veteran did use alcohol to cope with his PTSD. The Veteran reported drinking 8 to 10 shots of whisky every evening. He explained that he used alcohol to self-medicate. The private examiner opined that given the Veteran's history of alcohol use over 8 years and the current interview, it was the examiner's opinion that the Veteran more likely than not developed alcohol use secondary to his PTSD symptoms. The Veteran reported that he could keep up with his hygiene just fine but that he had difficulty completing activities of daily living such as household activities or yard work because he had a lack of energy and was lethargic around the house. The Veteran reported symptoms including depressed mood, anxiety, near-continuous panic or depression, mild memory loss, flattened affect, impaired judgment, disturbances of mood or motivation, difficulty in establishing and maintaining effective work and social relationships, difficulty in adapting to stressful circumstances including work or a work-like setting, hypervigilance, nightmares, physiological reactivity, disassociation, restricted affect, avoidance and social withdrawal, irritability, low mood, paranoia, chronic sleep impairment, chronic suicidal ideation, impaired impulse control, and ongoing negative beliefs and emotions about traumatic experiences while in the military. The Veteran reported chronic sleep impairment including difficulty initiating and maintaining sleep, feeling excessively tired and fatigued throughout the day, getting only 4 to 6 hours of sleep a night, having nightmares, and at least one incident of believing his wife was an insurgent and choking her while asleep. The Veteran reported a history of anger and rage to the extent that he had to be removed from his job and reassigned to another part of the district after a verbal altercation. The Veteran took a couple of days to 'calm down' and was reinstated in his role. The Veteran reported that he did speak with his family, that he had ups and downs with his marriage, and that his kids were afraid of him. The private examiner determined that the Veteran's symptoms effectively impaired his ability to secure and follow gainful employment and to perform effectively in the workplace. The Veteran expressed difficulty discussing the true severity of his symptoms. He described his symptoms as being so severe that he had chronic suicidal ideation and that despite being an avid hunter prior to service, he did not keep any guns in the house because of a prior suicide attempt. Lastly, the private examiner explained: "Notably, the record indicates VA exams dated (2/11/2012) and (4/30/2019) reports that the Veteran has previously minimized symptoms, which is in line with both American male culture, as well as military culture, where Veterans are punished or sanctioned for admitting or displaying weakness. [T]he current interviewer did not experience this issue, being successfully able to establish rapport with the Veteran, and as such, finds that the Veteran's PTSD symptomology is significantly more severe than these recent exams." The private examiner concluded: "In my professional opinion, since at least June 2010 to the present, [the Veteran's] psychiatric symptoms have resulted in occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood." Based upon the preceding evidence, the Board finds that for the period from April 20, 2019, the Veteran is entitled to a 70 percent disability rating for his service-connected PTSD. Even though the April 2019 VA examiner concluded that the Veteran's level of impairment more nearly approximated occupational and social impairment with occasional decrease in work efficiency (commiserate with a 30 percent evaluation), the Veteran consistently reported suicidal ideation since April 2019; near-continuous depression affecting the ability to function independently, appropriately, and effectively; unprovoked irritability; difficulty in adapting to stressful circumstances; and an inability to establish and maintain effective relationships. From April 20, 2019, they were of such frequency, severity, and duration as to equate to deficiencies in work, family relations, judgment, thinking, and mood. These are deficiencies more akin to a 70 percent evaluation. Moreover, since April 2019 the Veteran reported chronic suicidal ideation. Despite the VA examiners' characterizations of the Veteran's symptoms as more moderate and falling within a 30 percent evaluation, the ultimate determination as to the level of occupational and social impairment lies with the adjudicator not the examiner. Moore v. Shinseki, 555 F.3d 1369, 1373 (Fed. Cir. 2009); 38 C.F.R. § 4.2. The Board believes that this is a case where the positive evidence and the negative evidence are in a state of equipoise. Conversely, while this evidence supports the grant of a 70 percent disability rating, the Veteran's impairment cannot be described as "total," and the record does not show the type of cognitive and behavioral impairment reserved for a 100 percent evaluation. Such symptoms are neither complained of nor observed by medical health care providers, including gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. While the Veteran stated that he had chronic suicidal ideation, the Board finds that the Veteran was not a persistent danger to himself because he denied suicidal intents or plans. Crucially, the presence of certain symptoms is not necessarily determinative. These symptoms must also cause the occupational and social impairment in the referenced areas. While the evidence clearly demonstrates that the Veteran has some social and occupational impairment attributable to PTSD, his overall symptomatology is not consistent with the criteria for a 100 percent disability rating under DC 9411. Lastly, the Board acknowledges the March 2021 private examiner's opinion that the Veteran's service-connected PTSD was of such severity to warrant a 70 percent rating since June 2010. The Board notes that the private examiner relied on a review of the Veteran's records in formulating this opinion because the private examiner did not interview the Veteran until March 2021. The Board finds, however, that the preponderance of the evidence, as previously discussed, shows that a 70 percent rating was not warranted until April 30, 2019. Accordingly, the Board finds that, from April 30, 2019, the Veteran's impairment due to PTSD is most consistent with a 70 percent rating, and that the level of disability contemplated in DC 9411 to support the assignment of a 100 percent rating is absent. ROBERT N. SCARDUZIO Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Palombi 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.