Citation Nr: 21030497 Decision Date: 05/19/21 Archive Date: 05/19/21 DOCKET NO. 13-33 420 DATE: May 19, 2021 ORDER Prior to December 30, 2015, an initial rating in excess of 50 percent for posttraumatic stress disorder with major depressive disorder and alcohol abuse (PTSD) is denied. FINDING OF FACT Prior to December 30, 2015, Veteran's PTSD was manifested by psychiatric symptomatology resulting in occupational and social impairment with reduced reliability and productivity, without more severe manifestations that more nearly approximate occupational and social impairment with deficiencies in most areas, or total occupational and social impairment. CONCLUSION OF LAW Prior to December 30, 2015, the criteria for an initial rating in excess of 50 percent rating for PTSD have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.126, 4.130, Diagnostic Code (DC) 9411. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from November 1996 to November 2000 and from January 2003 to July 2003. He is the recipient of numerous awards and decorations, to include the Combat Action Ribbon. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a rating decision issued in June 2009 by a Department of Veterans Affairs (VA) Regional Office, which granted service connection for PTSD with an initial rating of 30 percent as of October 31, 2008. During the course of the appeal, a May 2013 rating decision awarded a higher initial rating of 50 percent, effective October 31, 2008, for the Veteran's PTSD. In June 2015, the Board remanded the case for additional development and, while on remand, a January 2016 rating decision awarded a 100 percent rating for his PTSD, effective December 30, 2015. As such is the maximum rating available for such disability, the only remaining issue before the Board in regard to such matter is entitlement to an initial rating in excess of 50 percent for PTSD prior to December 30, 2015. In October 2017, the Veteran and his girlfriend, K.C., testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the record. In January 2020, the Board denied the Veteran's claim for a higher initial rating for his PTSD prior to December 30, 2015. Thereafter, he appealed such decision to the United States Court of Appeals for Veterans Claims (Court), which, in December 2020, granted the Veteran's and the Secretary of VA's (the parties') Joint Motion for Remand (JMR), which vacated and remanded the Board's January 2020 decision. The case now returns for further appellate review. Entitlement to an initial rating in excess of 50 percent prior to December 30, 2015 for PTSD. 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 veteran working or seeking work. 38 C.F.R. § 4.2. All reasonable doubt will be resolved in the claimant's favor. 38 C.F.R. § 4.3. 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. Separate ratings can be assigned for separate periods based on the facts founda practice known as "staged" ratings. Fenderson v. West, 12 Vet. App. 119 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). Staged ratings are appropriate whenever the factual findings show distinct periods where the service-connected disability exhibits symptoms that would warrant different ratings. Id. The Veteran is currently in receipt of an initial 50 percent rating for his PTSD prior to December 30, 2015, pursuant to DC 9411, which provides that such disability is evaluated pursuant to the General Rating Formula for Mental Disorders. 38 C.F.R. § 4.130. He contends that such disability is more severe than as reflected by the currently assigned rating, and as such, a higher initial rating is warranted. Under the General Rating Formula, a 50 percent rating is warranted when 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 understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment, impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships. Id. A 70 percent rating is warranted where there is occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work like setting); inability to establish and maintain effective relationships. Id. A 100 percent rating is warranted when there is total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication, persistent delusions or hallucinations, grossly inappropriate behavior, persistent danger of hurting self or others, intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene), disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. Id. The United States Court of Appeals for the Federal Circuit has held that the evaluation under 38 C.F.R. § 4.130 is "symptom-driven," meaning that "symptomatology should be the fact-finder's primary focus when deciding entitlement to a given disability rating" under that regulation. See Vazquez-Claudio v. Shinseki, 713 F.3d 112, 116-117 (Fed. Cir. 2013). The symptoms listed are not exhaustive, but rather "serve as examples of the type and degree of symptoms, or their effects, that would justify a particular rating." Mauerhan v. Principi, 16 Vet. App. 436, 442 (2002). In the context of determining whether a higher disability evaluation is warranted, the analysis requires considering "not only the presence of certain symptoms, but also that those symptoms have caused occupational and social impairment in most of the referenced areas"i.e., "the regulation...requires an ultimate factual conclusion as to the Veteran's level of impairment in most areas." Vazquez-Claudio, 713 F.3d at 117118; 38 C.F.R. § 4.130, DC 9411. Further, when evaluating a mental disorder, the Board must consider the "frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the Veteran's capacity for adjustment during periods of remission," and must also "assign an evaluation based on all the evidence of record that bears on occupational and social impairment rather than solely on the examiner's assessment of the level of disability at the moment of the examination." 38 C.F.R. § 4.126(a). In Bankhead v. Shulkin, 29 Vet. App. 10 (2017), the Court held that the language of the general rating formula "indicates that the presence of suicidal ideation alone may cause occupational and social impairment with deficiencies in most areas." However, as recognized by the Court, VA must engage in a holistic analysis in assessing the severity, frequency, and duration of the signs and symptoms of a veteran's service-connected psychiatric disability, and their resulting social and occupational impairment. Effective August 4, 2014, VA amended the portion of its Schedule for Rating Disabilities dealing with mental disorders and its adjudication regulations that define the term "psychosis" to remove outdated references to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) and replace them with references to the recently updated Fifth Edition (DSM-5). See 79 Fed. Reg. 149, 45094 (August 4, 2014). The provisions of the interim final rule apply to all applications for benefits that are received by VA or that were pending before the Agency of Original Jurisdiction (AOJ) on or after August 4, 2014. VA adopted as final, without change, the interim final rule and clarified that the provisions of this interim final rule do not apply to claims that have been certified for appeal to the Board or are pending before the Board as of August 4, 2014, even if such claims are subsequently remanded to the AOJ. See 80 Fed. Reg. 53, 14308 (March 19, 2015). In the instant case, the Veteran's claim was certified to the Board in February 2014 and, as such, the DSM-IV applies to his claim. In this regard, the Board notes that the DSM-5 removed reference to Global Assessment of Functioning (GAF) scores. However, as the DSM-IV governs the Veteran's claim, such scores are relevant to the evaluation of his PTSD. A GAF score is another component considered to determine the entire disability picture for the Veteran. The GAF scale is a scale reflecting the "psychological, social, and occupational functioning on a hypothetical continuum of mental health-illness" from 0 to 100, with 100 representing superior functioning in a wide range of activities and no psychiatric symptoms. Carpenter v. Brown, 8 Vet. App. 240, 242 (1995) (quoting Diagnostic and Statistical Manual of Mental Disorders 32 (4th ed. 1994)). Although GAF scores are important in evaluating mental disorders, the Board must consider all the pertinent evidence of record and set forth a decision based on the totality of the evidence in accordance with all applicable legal criteria. Carpenter, supra. An assigned GAF score, like an examiner's assessment of the severity of a condition, is not dispositive of the percentage rating issue; rather, it must be considered in light of the actual symptoms of a psychiatric disorder (which provide the primary basis for the rating assigned). See 38 C.F.R. § 4.126 (a). Accordingly, an examiner's classification of the level of psychiatric impairment, by word or by a GAF score, is to be considered, but is not determinative of the percentage VA disability rating to be assigned; the percentage evaluation is to be based on all the evidence that bears on occupational and social impairment. Id.; see also 38 C.F.R. § 4.126, VAOPGCPREC 10-95, 60 Fed. Reg. 43186 (1995). After a review of the record, to include the evidence highlighted in the JMR, the Board finds that the Veteran is not entitled to an initial rating in excess of 50 percent for his PTSD prior to December 30, 2015. In this regard, the record indicates that the Veteran attended both individual and group therapy sessions as well as couples therapy from October 2008 to June 2015. During such time, the Veteran reported trouble sleeping and nightmares, and he indicated that he avoids social situations. He has repeatedly denied suicidal or homicidal ideations, hallucinations, or obsessional rituals. Mental status examinations found the Veteran to be alert and oriented, his thoughts linear and goal-directed, and his speech to be regular in rate and tone. Judgment and insight appeared to be fair to good while psychosis and gross cognitive or memory deficits were not found. The Veteran was found to be cooperative with appropriate grooming and hygiene, but with mostly poor eye contact. A January 2009 mental health assessment notes the Veteran reported symptoms of irritability and frustration, nightmares, depression, and sleep impairment. In this regard, he indicated that he was not sleeping well, and appeared to be acting out combat situations in sleep. Specifically, he talked in his sleep, moved, and swung his arms, and had accidentally hit his girlfriend while asleep. Further, he reported wanting to be alone and avoiding social situations, if possible, but denied feelings of hopelessness and anxiety, panic attacks, obsessional rituals, paranoia, or suicidal ideations. In May 2009, the Veteran was afforded a VA examination. At such time, the VA examiner opined that, generally, the Veteran functioned satisfactorily with routine behavior, self-care and normal conversation. In this regard, it was noted that he exhibited depressed mood, anxiety, suspiciousness, chronic sleep impairment, impaired impulse control and some unprovoked irritability. However, he did not have hallucinations or suicidal or homicidal ideations, and his orientation, appearance, hygiene, behavior, communication, speech, concentration, thought process, abstract thinking, judgment, and memory were normal. Panic attacks, while present, occurred less than once a week. Regarding the Veteran's occupational functioning, the examiner reported that he functioned at work, and he described his relationship with his supervisor and co-workers as "fair." With respect to the Veteran's social functioning, he reported being close to his mother and half-sister and had been in a relationship with his girlfriend, K.C., since 2003, although he felt that relationship had become unstable. Thus, the VA examiner opined that his current psychiatric symptoms cause occupational and social impairment with occasional decrease in work efficiency and intermittent inability to perform occupational tasks, which is consistent with a 30 percent rating under the General Rating Formula. In October 2009, the Veteran underwent a PTSD evaluation with a private provider, Dr. I.B. At such time, it was noted that he exhibited avoidance and arousal symptoms that were intense and severe, poor judgment, reduced reliability due to flattened affect, impairment of short-term memory, and difficulty in establishing and maintaining effective social and work relationships. He cited to the fact that the Veteran had few social relationships beyond his girlfriend and was prone to violent outbursts, constantly irritable, and highly anxious. Dr. I.B. assigned the Veteran a GAF score of 45. Such score is indicative of serious symptoms such as suicidal ideation, severe obsessional rituals or frequent shoplifting, but the Veteran was not shown to exhibit these symptoms at any time during the appeal period. Instead, his symptoms, as described by Dr. I.B., most nearly approximate the 50 percent rating criteria for PTSD. In this regard, the Veteran did not exhibit suicidal ideation, obsessional rituals, near-continuous panic, or difficulty with speech, spatial orientation or personal appearance or hygiene, all symptoms contemplated by the 70 percent rating criteria. Furthermore, this opinion is, in part, based on statements provided by the Veteran's girlfriend rather than on the medical or psychological evaluation of the Veteran by Dr. I.B. In addition, Dr. I.B. has rated the severity of the Veteran's symptoms in part to the detrimental affect they have on the Veteran's girlfriend, rather than on how such symptoms impair the Veteran's occupational and social functioning. Accordingly, the Board affords Dr. I.B.'s opinion less probative weight than the other psychiatric evaluations of record. With regard to the Veteran's social functioning, at the time of his May 2009 VA examination, he reported being close to his mother and half-sister. However, in July 2011, he indicated that he did not have close relationships with his parents or half-siblings. The Veteran further reported that he did not have many friends, although there are friends he talks with on the phone and one friend who he visits "once in a while." He also reported feeling less and less social. See July 2011 VA Treatment Record. At the October 2017 Board hearing, the Veteran testified that he withdrew from his family and friends because he felt he was not understood. However, through the entire appeal period, he has remained in a long-term relationship with K.C. Although at times turbulent, the couple has maintained their relationship since 2003 and, during mental health evaluations, the Veteran states he feels supported by her. See October 2012 and April 2013 VA Treatment Records. The couple engaged in counseling from January 2009 through June 2015. In this regard, in a January 2009 mental health assessment, K.C. describes the Veteran as having difficulty sleeping, lashes out, and avoids most social situations. In October 2009, there was an incident in which the Veteran hit his girlfriend with a book. This incident resulted in a Violence Risk Assessment, in which the Veteran was determined to present a low risk for violence. See October 2009 Violence Risk Assessment. Additionally, there was another reported incident in which the Veteran hit his girlfriend in the mouth with the back of his hand. See October 2010 progress note. Counselor reports following the two aforementioned incidents acknowledged the Veteran's tendency to be verbally abusive and, at times, physically aggressive, as in the case of hitting his girlfriend with a book and on the mouth with his hand. See October 2, 2009, Clinical Psychologist PTSD Evaluation; October 18, 2010, Readjustment Counselor Progress Note. Also in September 2010, a counselor noted that the Veteran experienced the impulse to smash his girlfriend's phone if she breaks a rule; however, there is no indication that he took such action. Rather, such serves as an example of the Veteran's ability to control his impulse, despite his irritability or frustration. A few months later, a psychiatrist noted the Veteran's report of often feeling moody and irritable, with anger and road rage; however, such only indicates that the Veteran described experiencing such emotions and does not demonstrate that he acted on such feelings since the isolated incidents two years previously. The 2009 clinical evaluation was again discussed in a June 2014 Statement in Support of Claim, but this statement also appears to simply reference the previously evaluated and discussed incidents. Moreover, in January 2012, both the Veteran and K.C. denied further aggressive behavior, the Veteran denied suicidal and violent ideation, and he did not endorse any other symptoms of his PTSD. Further, in April 2012, the Veteran reported that he was doing well, stating "I feel fine." At that time, he denied irritability, depressed mood, and suicidal or violent ideation, and reported sleeping well. While it was noted in May 2012 that he reported throwing things when irritable, there was no indication that he was violent towards people. Again, in October 2012, the Veteran described himself as "pretty stable," sleeping 7 to 8 hours per night, without mood swings, or impulsive behavior. He denied panic attacks, anxiety, flashbacks, nightmares, and suicidal or homicidal ideations. In April 2013, the Veteran reported significant improvement since 2009, and, in October 2013 he stated that he did not feel that his PTSD symptoms interfered with relationships or work. With respect to the Veteran's occupational functioning, he testified that, through much of the appeal period, he has maintained part-time work in the film industry. In this regard, he has worked as a production assistant and an extra on movie and TV sets, to include the History Channel and CSI Miami. However, the Veteran also testified that working on action shots during movie scenes became very difficult due to his PTSD. He mentioned a particular incident in which a bus exploded on set, causing him to feel "really uncomfortable." Further, the Veteran testified that he has major anxiety regarding commuting on the freeway during traffic. Nonetheless, during the appeal period, the Veteran was also enrolled in school in which he pursued a degree in film production. He repeatedly reported that school was going "ok" or "well." See April 2009, August 2011, October 2011, October 2012 and April 2013 VA Treatment Records. Further, during the appeal period, using his own money the Veteran directed and produced a short film in Florida, requiring work travel and reshooting to replace lost film. See September 2009 VA Treatment Record. During periods of unemployment, the Veteran was involved in internet projects and selling and reselling items on eBay and Amazon or working as a freelance film maker. See October 2012 and August 2014 Treatment Records. Unfortunately, in September 2014, the Veteran's father passed away. As a result, he reported a worsening of his PTSD symptoms, including impulsivity, irritability, flashbacks, nightmares, and hypervigilance. However, there is no indication of obsessional rituals as a result of hypervigilance. Further, in mental health evaluations after his father's death, the Veteran continued to deny hopelessness, suicidal or homicidal ideations, and hallucinations. Additionally, he presented as calm and cooperative, his thoughts linear and goal-directed, and his speech to be regular in rate and tone. Judgment and insight appeared to be fair. The Veteran was found to be cooperative with appropriate grooming and hygiene with good eye contact. In April 2015, the Veteran completed a work trip to Las Vegas where he presented and promoted short films he produced. At the conclusion of the trip, the Veteran reported feeling better with an improvement in his anxiety. See April 2015 VA Treatment Record. About this time, the Veteran also expressed interest in bereavement counseling to help deal with the sadness related to his father's death. See May 2015 VA Treatment Record. In May 2015 and June 2015, the Veteran reported an overall improvement in his symptoms. At the December 2015 VA examination, which was the basis for the increased rating to 100 percent, the examiner found that the Veteran's PTSD symptoms had worsened as demonstrated by the symptoms reported at such examination, to include suicidal ideation, and, at such time, resulted in occupational and social impairment with deficiencies in most areas, which is consistent with a 70 percent rating under the General Rating Formula. Based on the foregoing, the Board finds that, an initial rating in excess of 50 percent for PTSD for the appeal period prior to December 30, 2015, is not warranted. In this regard, the Veteran has never reported symptoms commensurate with a 100 percent rating, nor do treatment records or examinations reflect any such symptoms throughout such appeal period. Furthermore, while he has reported impaired impulse control (unprovoked irritability with periods of violence), which is contemplated by a 70 percent rating, such is not shown to be of a nature, frequency, duration, and severity as to result in occupational and social impairment with deficiencies in most areas. Specifically, the record reflects only two instances where the Veteran hit his girlfriend with a book and his hand, which resulted in K.C.'s report that he was verbally abusive and physically aggressive, as well as his reports of throwing things when angry, experiencing road rage, and a desire to smash his girlfriend's phone. However, as previously discussed, he was only violent towards another person on two occasions, which resulted in a full psychological evaluation with an assessment that he was at low risk for violence. Moreover, despite experiencing feelings of irritability, angry, and road rage, he has routinely maintained impulse control. Further, while the Veteran had been found to have difficulty in adapting to stressful circumstances (including work or work like settings), he worked as a movie extra, production assistant, completed courses in a film production curriculum, and produced short films. Additionally, while the Veteran had reported difficulty with establishing and maintaining effective social relationships, he has, in fact, maintained a close relationship since 2003 with his girlfriend. Thus, while he has some difficulty establishing and maintaining relationships, he had not been shown to be unable to do so. Moreover, at times, the Veteran has reported improving symptoms and consistently denied suicidal ideations, obsessional rituals, and has never suffered from difficulties with speech or neglected his personal appearance or hygiene during the appeal period. In this regard, the Board notes that parties to the JMR found that the Board erred in failing to discuss the Veteran's report of suicidal ideation at the December 2015 VA examination; however, a 100 percent rating for his PTSD was assigned as of the date of such examination, which fully contemplates suicidal ideation. Additionally, as noted previously, the examiner specifically found that such disability had increased as of the date of the examination in light of the symptoms reported that day and, the Board again notes that, for the period prior to such date, the Veteran consistently denied experiencing suicidal ideation. Moreover, the remainder of the Veteran's psychiatric symptoms noted throughout the appeal period are explicitly contemplated by the rating criteria for a 30 or 50 percent rating under the General Rating Formula. Furthermore, regardless of the classification of the Veteran's symptoms under the General Rating Formula, the Board finds that the totality of such, to include consideration of their nature, frequency, duration, and severity, result in, at most, occupational and social impairment with reduced reliability and productivity prior to December 30, 2015. In this regard, as noted previously, the Veteran was able to maintain a close relationship with his long-term girlfriend, attending counseling together. Moreover, the record shows that the Veteran has been able to maintain employment in the film industry and attended school throughout much of the appeal period. In this regard, it is clear that the Veteran's psychiatric disability did not result in more than moderate impairment in his occupational functioning as he was able to perform the mental functions necessary for such jobs. The Board has also considered the Veteran's GAF scores assigned during the course of the appeal. A GAF score is highly probative as it relates directly to the Veteran's level of impairment of social and industrial adaptability, as contemplated by the rating criteria for mental disorders. See Massey v. Brown, 7 Vet. App. 204, 207 (1994). A GAF score of 41 to 50 denotes serious symptoms (e.g. suicidal ideation, severe obsessional rituals, frequent shoplifting) or any serious impairment in social, occupational, or school functioning (e.g., no friends, unable to keep a job). A GAF score of 51 to 60 represents moderate symptoms (e.g., flat affect and circumstantial speech, occasional panic attacks) or moderate difficulty in social, occupational, or school functioning (e.g., few friends, conflicts with coworkers). While the Veteran was assigned a GAF score of 45 in October 2009 by Dr. I.B., this appears to be an outlier as the remainder of his scores were consistent with symptoms in the moderate range, and therefore indicative of a 50 percent rating. In this regard, the May 2009 VA examiner assigned a score of 55. Further, the Veteran was assigned GAF scores of 55 in October 2011, 59 in March 2012, and 60 in December 2010 and April 2013. Thus, the Board finds that the symptoms reported at the time of the assignment of such GAF scores do not reflect more than moderate symptoms consistent with a 50 percent rating. Therefore, based on the foregoing, the Board finds that, prior to December 30, 2015, Veteran's PTSD was manifested by psychiatric symptomatology resulting in occupational and social impairment with reduced reliability and productivity, without more severe manifestations that more nearly approximate occupational and social impairment with deficiencies in most areas, or total occupational and social impairment. Thus, an initial rating in excess of 50 percent for such disability prior to December 30, 2015, is not warranted. The Board has also considered whether staged ratings under Fenderson, supra, are appropriate for the Veteran's service-connected PTSD; however, the Board finds that such symptomatology has been stable throughout the appeal period. Therefore, assigning staged ratings is not warranted. Further, neither the Veteran nor his representative have raised any other issues, nor have any other issues been reasonably raised by the record in connection with the initial rating claim adjudicated herein. Doucette v. Shulkin, 28 Vet. App. 366 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). In this regard, pursuant to the JMR, the Board has considered whether a claim of entitlement to a TDIU has been raised in connection with the Veteran's claim for a higher initial rating for his PTSD. Rice v. Shinseki, 22 Vet. App. 447, 453 (2009). Specifically, the parties noted that, at the December 2015 VA examination, the Veteran reported that he had not worked since 2012 as his PTSD symptoms got in the way. However, as previously discussed, such report is contradicted by the contemporaneous evidence of record reflecting that the Veteran worked throughout much of the appeal period in the film industry, to include as a production assistant and an extra on movie and TV sets; directed and produced his own short film in Florida; and attended a work trip in Las Vegas where he presented and promoted short films he produced as recently as April 2015. Moreover, during periods of unemployment, the Veteran pursued a degree in film production, sold items on eBay and Amazon, and worked as a freelance film maker. Thus, while his PTSD symptoms presented difficulty on when shooting certain scenes involving explosions and while commuting in traffic on the freeway, the evidence shows that he consistently maintained the ability to work throughout the appeal period. Consequently, the Board finds that, at no point pertinent to the appeal period has a claim of entitlement to a TDIU been raised. Furthermore, as of December 30, 2015, a TDIU based on the Veteran's PTSD is moot as he is in receipt of a 100 percent rating for such disability. In sum, the Board finds that the preponderance of the evidence is against an initial rating in excess of 50 percent prior to December 30, 2015 for the Veteran's PTSD. Therefore, the benefit of the doubt doctrine is not applicable to the instant claim and his claim for a higher initial rating for his PTSD must be denied. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. A. JAEGER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Breckenridge, Associate Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.