Citation Nr: 21031648 Decision Date: 05/24/21 Archive Date: 05/24/21 DOCKET NO. 10-35 043 DATE: May 24, 2021 ORDER The appeal challenging the propriety of the reduction of the disability evaluation from 100 percent to 50 percent, effective June 1, 2008, for post-traumatic stress disorder (PTSD), to include reduction of special monthly compensation (SMC), is denied. FINDINGS OF FACT 1. By rating action of September 2004, a 100 percent disability rating was assigned for PTSD from June 28, 2004, the date of claim for an increased rating. 2. Following examinations of September 2006 and May 2007, which were determined to demonstrate actual and sustained improvement in symptoms, the Veteran's rating was reduced to 50 percent disabling effective June 1, 2008. 3. The objective medical evidence shows that, after June 1, 2008, symptoms of PTSD did not reflect the criteria for a 100 percent disability rating under the General Rating Formula for Mental Disorders. CONCLUSION OF LAW The reduction in the disability rating for PTSD, effective June 1, 2008, was proper. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.105, 3.321, 4.130, Diagnostic Code 9411 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty in the United States Army from November 1962 to December 1972. In June 2013, the Veteran testified at a Central Office Board hearing before the undersigned Veterans Law Judge. A transcript of that hearing is of record. As discussed below, this claim was previously denied by the Board, appealed to the Court of Appeals for Veterans Claims, returned to the Board in a Joint Motion for Remand, agreed to and submitted by the parties, the Board again denied the claim, and, in November 2020, the Court returned the matter to the Board for action consistent with the Joint Motion for Partial Remand (JMPR). Schedular Ratings Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities (rating schedule), found in 38 C.F.R. Part 4. When a reasonable doubt arises regarding the degree of disability, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. 38 C.F.R. § 4.7. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107; see also Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). Additionally, it is possible for a veteran to be awarded separate percentage evaluations for separate periods (staged ratings), based on the facts. See Fenderson v. West, 12 Vet. App. 119, 12627 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). The rating schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of, or incident to, military service. The ratings are intended to compensate, as far as can practicably be determined, the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. In considering the severity of a disability, it is essential to trace the medical history of the veteran. 38 C.F.R. §§ 4.1, 4.2, 4.41; Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Consideration of the whole-recorded history is necessary so that a rating may accurately reflect the elements of disability present. 38 C.F.R. § 4.2; Peyton v. Derwinski, 1 Vet. App. 282 (1991). Where an increase in the disability rating is at issue, the present level of the veteran's disability is the primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). However, the relevant overall temporal focus for adjudicating an increased rating claim is on the evidence concerning the state of the disability from the time period one year before the claim was filed until VA makes a final decision on the claim. Hart v. Mansfield, 21 Vet. App. 505 (2007). The evaluation of the same disability under several diagnostic codes, known as "pyramiding," must be avoided; however, separate ratings may be assigned for distinct disabilities resulting from the same injury so long as the symptomatology for one condition is not duplicative of or overlapping with the symptomatology of the other condition. 38 C.F.R. § 4.14 (2019). Reduction of Ratings In its September 2006 rating decision, the Agency of Original Jurisdiction (AOJ) proposed to reduce the Veteran's 100 percent rating for PTSD to a 50 percent rating, as well as discontinue SMC benefits. A March 2008 rating decision accomplished the reduction of both PTSD and SMC, effective June 1, 2008. A set of procedural safeguards governing rating reductions is outlined in 38 C.F.R. § 3.105, which are required to be followed by VA before it issues any final rating reduction. See Brown v. Brown, 5 Vet. App. 413, 418 (1993). In the instant case, the AOJ procedurally complied with 38 C.F.R. § 3.105, regarding the manner in which the Veteran was given notice of the proposed rating reduction and the implementation of that reduction. Notice of the proposed rating reduction, including the evidentiary basis for this proposal, was provided to the Veteran in a September 2006 notification letter. This notice also informed the Veteran that he could submit additional evidence to show that the compensation payments should not be reduced and advised him of his right to request a pre-decisional personal hearing. As the Board finds the AOJ has fulfilled its procedural requirements set forth under 38 C.F.R. § 3.105 for rating reductions, the Board will now consider the propriety of the rating reduction itself. The provisions of 38 C.F.R. § 3.344 (a) and (b) provide that, when a veteran's schedular rating has been both continuous and stable for 5 years or more, the rating may be reduced only if the examination on which the reduction is based is at least as full and complete as the examination used to establish the higher evaluation. A rating in effect for more than 5 years will not be reduced on the findings of any one examination, except in those instances where all the evidence of record clearly warrants the conclusion that sustained improvement has been demonstrated. At the time the reduction became effective, June 1, 2008, the 100 percent rating for PTSD had not been continuously in effect for a period of over 5 years and, as such, the provisions of 38 C.F.R. § 3.344 (a) and (b) are not applicable. The rating agency must also take into consideration whether the evidence makes it reasonably certain the improvement will be maintained under the ordinary conditions of life. See Kitchens v. Brown, 7 Vet. App. 320 (1995); Brown v. Brown, supra. In considering the propriety of a reduction, the Board must focus on the evidence available to the AOJ at the time the reduction was effectuated (although post-reduction medical evidence may be considered in the context of considering whether actual improvement was demonstrated). Dofflemyer v. Derwinski, 2 Vet. App. 277, 281-82 (1992). The Veteran need not demonstrate that he is entitled to retain the higher evaluation; rather, it must be shown by a preponderance of the evidence that the AOJ's reduction was warranted. See Brown v. Brown, supra; Kitchens v. Brown, supra (1995). Propriety of the reduction of the disability evaluation from 100 percent to 50 percent, effective June 1, 2008, for PTSD, to include reduction of SMC benefits. PTSD is rated under Diagnostic Code 9411. However, most psychiatric disorders, including PTSD, although assigned separate diagnostic codes, are evaluated under the General Rating Formula for Mental Disorders (General Rating Formula). 38 C.F.R. § 4.130. Under the General Rating Formula, a 50 percent evaluation requires demonstrated evidence of occupational and social impairment, with reduced reliability and productivity due to such symptoms as: a flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; and/or difficulty in establishing and maintaining effective work and social relationships. 38 C.F.R. § 4.130, Diagnostic Code 9411 (2020). A 70 percent disability rating is warranted for occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work-like setting); inability to establish and maintain effective relationships. Id. A 100 percent disability rating will be assigned 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. Id. The symptoms listed in the General Rating Formula are not intended to constitute an exhaustive list, but rather serve as examples of the type and degree of symptoms, or their effects, that would justify a rating. Mauerhan v. Principi, 16 Vet. App. 436 (2002). If the evidence demonstrates that the claimant's psychiatric disorder produces symptoms and resulting occupational and social impairment equivalent to that set forth in the criteria for a given rating, then that rating will be assigned. Mauerhan, 16 Vet. App. at 443. Global Assessment of Functioning (GAF) scores are a scale reflecting the "psychological, social, and occupational functioning on a hypothetical continuum of mental health-illness." See Carpenter v. Brown, 8 Vet. App. 240, 242 (1995); see also Richard v. Brown, 9 Vet. App. 266, 267 (1996) (citing the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) at 32). As relevant to the record, a GAF score between 51 and 60 is defined as "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 peers or coworkers)," while a score between 61 and 70 is defined as "some mild symptoms (e.g., depressed mood and mild insomnia) or some difficulty in social, occupational, or school functioning (e.g., occasional truancy, or theft within the household), but generally functioning pretty well, with some meaningful interpersonal relationships." While the Rating Schedule does indicate that the rating agency must be familiar with the Diagnostic and Statistical Manual of Mental Disorders, it does not assign disability percentages based solely on GAFs cores. See 38 C.F.R. § 4.130. Rather, GAF score of scores are but one factor to be considered in conjunction with all other pertinent evidence of record. As it is, the Board is fully aware that the DSM IV, which used GAF scores, was superseded in May 2013 by DSM 5 (5th edition), which does not. Nonetheless, the GAF scores were assigned in the period prior to the advent of DSM 5 and, if necessary, are for relevant consideration in the period at issue. Turning to the record, in an October 2003 VA initial psychological evaluation note, the Veteran was diagnosed with depression, NOS (not otherwise specified), with a GAF score of 52 assigned, indicating moderate symptoms. Mental status examination findings were as follows: The Veteran appeared slouched, with psychomotor retardation; he was teary; slow speech; fair eye contact; orientation within normal limits; activities of daily living within normal limits; poor sleep, appetite and energy; anxiety within normal limits; depressed affect and mood; mild difficulty with concentration and memory; thought processes within normal limits; emotional withdrawal, interpersonal distancing and social withdrawal; insight and judgment within normal limits; and no past suicidal or homicidal ideation/attempts. In January 2004, the Veteran underwent a Clinician Administered PTSD Scale (CAPS), conducted to provide a method to evaluate the frequency and intensity of individual symptoms, as well as the impact of the symptoms on social and occupational functioning. The CAPS note stated the Veteran met the full criteria for a diagnosis of combat-related PTSD, moderate. It further noted the Veteran's reports of difficulty in re-experiencing stressor events, with resulting dreams and sweats; avoidance of thoughts, feelings and activities prompting associations with trauma; falling and staying asleep; hypervigilance; startle response; and sadness and depression. The Veteran further reported a mild impact of the symptoms on social functioning and a moderate impact on occupational functioning. A GAF score of 52 was assigned, indicating moderate symptoms. A VA psychiatric transition note later in January 2004 notes that the Veteran's prominent PTSD symptoms are difficulty managing recurrent and intrusive thoughts related to his combat experiences, day and night sweats, difficulty sleeping, and depressive features. In this period, no past suicide attempt or history of violence was noted in the Veteran's overall history. As already stated, the increased evaluation to 100 percent was based on the findings of the March 2004 VA examination for PTSD, in which the VA examiner found the Veteran met the relevant criteria and examiner diagnosed the Veteran with PTSD and assigned a GAF score of 53, indicating moderate symptoms. The March 2004 VA examiner found the Veteran's social functioning included appropriately interacting with others, engages in social activities, capable of activities of daily living, able to meet family responsibilities, and able to meet work demands and responsibilities. She further found employment was affected by PTSD symptoms at a mild level; activities of daily living at a moderate level; routine responsibilities at a mild level; the Veteran's family role was affected at a moderate level; relationships at a severe level; leisure activities at a mild level; and quality of life at a moderate level. Mental status examination findings of symptoms were as follows: No impairment of thought process or communication; no delusions, hallucination or their persistence; behavior was appropriate; no current suicidal ideation, thoughts, plans or intent; however, there had been past suicidal or homicidal ideation without plan or attempts; ability to maintain personal hygiene and basic activities of daily living; the Veteran was oriented to time, place and person; no memory loss or impairment; no presence of obsessive or ritualistic behavior which interferes with routine activities; normal rate and flow of speech; panic attacks one or twice a month, likely trauma related, frequently of an hour's duration and reported as very distressing and "very uncomfortable;" the presence of depression related to unemployment, but sad mood, low energy and hopelessness were denied; no impaired impulse control; sleep impairment at four hours per night with medication; In the September 2006 VA examination for PTSD, the VA examiner diagnosed the Veteran with PTSD and assigned a GAF score of 58, indicating moderate symptoms. Findings of social functioning show the Veteran appropriately interacts with others, engages in social activities and is capable of basic activities of daily living. Specifically, the Veteran reported engaging in boating and fishing with family members and participants in his PTSD therapy group at VA. The Veteran further reported, although unemployed, he does not contend that it is due to the effects of a mental disorder. Results of the mental status examination showed the following symptoms: No impairment of thought process or communication; no delusions hallucinations and their persistence; behavior was appropriate; no current suicidal thoughts, ideation, plans, or intent; no past suicidal or homicidal thoughts, ideation, plans, or intent; is able to maintain personal hygiene and basic activities of daily living; oriented to oriented to time, place and person; no memory loss or impairment; no presence of obsessive or ritualistic behavior which interferes with routine activities; normal rate and flow of speech; no panic attacks present; no presence of depression, depressed mood or anxiety; no impaired impulse control; and experiences sleep impairment, with frequent nightmares. Symptoms were found not to affect employment, activities of daily living, routine responsibilities, family role, leisure activities, or quality of life. However, the September 2006 VA examiner found they affected physical health and relationships moderately. In the May 2007 VA examination for PTSD, the VA examiner diagnosed the Veteran with PTSD, chronic and assigned a GAF score of 50, indicating serious symptoms. Findings of social functioning showed the Veteran isolates himself, appropriately interacts with others, engages in social activities, is capable of basic activities of daily living, and is able to meet family responsibilities. The mental status examination revealed symptoms as follows: No impairment of thought process or communication; no delusions, hallucinations and their persistence; behavior was appropriate; no current suicidal thoughts, ideation, plans, or intent; no past suicidal or homicidal thoughts, ideation, plans, or intent; is able to maintain personal hygiene and basic activities of daily living; oriented to oriented to time, place and person; no memory loss or impairment; no presence of obsessive or ritualistic behavior which interferes with routine activities; normal rate and flow of speech; no panic attacks present; the Veteran's mood is depressed to a moderate degree, with irritability; no impaired impulse control; and there is sleep impairment of PTSD-induced insomnia complicated by possible sleep apnea. The May 2007 VA examiner found symptoms affect routine responsibilities and physical health at a mild level; activities of daily living, family role and relationships at a moderate level; and leisure activities and quality of life at a severe level. The parties to the November 2020 JMPR agree that the Board must provide a written statement of the reasons or bases for its findings and conclusions which contains sufficient information to enable an appellant to understand the precise basis for its decision and to facilitate review in this Court. Specifically, the parties agree the Board did not adequately support its conclusion that the September 2006 and May 2007 VA examinations demonstrated actual and sustained improvement in the Veteran's PTSD symptoms and the Board did not accurately apply 38 U.S.C. § 1114 (s) in the issue of the reduction of SMC benefits. The JMPR identifies the following series of specific findings by the Board and for each states why the Board did not adequately explain why it made the finding. The parties first agree the Board did not adequately explain why the Veteran's denial of past suicidality in 2006 and 2007 reflected an improvement in his service-connected PTSD, given his previous endorsement of suicidal or homicidal ideation without plan or attempts in 2004 and in turn why that indicates actual and sustained improvement. The parties add that the Veteran's May 2007 testimony, given before the Regional Office Decision Review Officer (DRO), specifically noted that the Veteran was "confused" by "[s]ome of the questions" during the September 2006 VA examination, as he was not certain whether he was being asked if "he had suicidal tendencies at that particular time" of the examination interview and to which he responded no. The Veteran added at the DRO hearing that in fact he has had suicidal tendencies prior to the 2006 examination and he misunderstood the September 2006 VA examiner's question. However, the Board notes that the DRO in fact scheduled the VA examination which followed later in May 2007 for the specific reason for the Veteran to have the opportunity to give his reports when not "confused." The DRO advised the Veteran to ask for clarification if he does not understand a question, specifically, to determine if the VA examiner means is the Veteran experiencing symptoms of suicidal ideation at present as an ongoing symptom or does the VA examiner mean at some time in the past or intermittently. Significantly, in the May 2007 examination, the Veteran once again responded "no" to whether he has "[c]urrent suicidal thoughts, ideation, plans or intent." The VA examiner commented, "NONE AND NO HX [history] OF SUICIDAL BAHAVIOR." Additionally, the Veteran responded "no" to whether he has had "[p]ast suicidal or homicidal thoughts, ideation, plans or intent." The Board also notes the DRO stated VA does not rate on a prognosis, but rather "based on what the examiner found...." Both the 2006 and May 2007 VA examiners did not find suicidal ideation, based on the Veteran's own reports. The Board will add, that as a factual determination for the purposes of adjudication, this statement of the DRO implies that previous endorsements in March 2004 of past suicidal ideation are not for consideration "by comparison" to the current findings in the September 2006 and May 2007 VA examinations. The rating criteria under the General Rating Formula for a total rating (100 percent) include, by way of example, the "persistent danger of hurting [one's] self or others." The Veteran reported in the 2006 and 2007 VA examinations he had no current or suicidal thoughts, ideation, plans, or intent. The Board finds those symptoms to be reasonably similar to and in fact suggested by "persistent danger of hurting [one's] self...." Moreover, in considering symptoms of psychiatric disorders, 38 C.F.R. § 4.126 (a) directs that the Board also notes that it "shall consider frequency, severity, and duration of psychiatric symptoms...." The passage of approximately 2 12 and 3 years from the March 2004 VA examination to the September 2006 and May 2007 VA examination, respectively, when the Veteran's reports indicating no current danger of self-harm, no past danger of self-harm and even, as it appears in the May 2007 VA examination, "NO HX [history] OF SUICIDAL BEHAVIOR," establishes the absence of a frequency and/or duration of the persistent danger of the Veteran hurting himself. Therefore, the Board finds improvement from the period prior to the March 2014 VA examination. The rating criteria for a 50 percent rating under the General Rating Formula more closely suggest the Veteran's improved symptoms, as the 70 percent criteria include suicidal ideation or something of reasonable similarity of severity. The Board further finds actual and sustained improvement has been indicated by the record of treatment. For example, in the period between October 2009 and at least August 2014, the Veteran's VA group therapy notes show he was assessed for "risk" as neither reporting nor exhibiting any indicators thereof. Additionally, the Veteran consistently appeared for the monthly sessions, appropriately dressed and groomed and exhibiting motivation by contributing to group discussions on many issues, thereby indicating improvement in the ordinary conditions of life. The Veteran's rating was then increased to 70 percent, effective March 18, 2014. The parties also agree that the Board did not adequately support its suggestion that the Veteran's March 2004 report of past suicidal ideation or homicidal ideation without plan or attempts may have justified the increase to a total disability evaluation, effective June 28, 2004, adding, "particularly given that the September 2004 rating decision that granted Appellant an increased 100 [percent] disability rating for PTSD did not mention suicidality as a basis for that disability rating. However, the September 2004 rating decision granting the temporary total rating decision directly quotes the rating criteria under the General Rating Formula for a 100 percent rating, to include "persistent danger of hurting self or others." As already discussed above, suicidal thoughts, ideation, plans, or intent are suggested by, if not reasonably similar to, the persistent danger of self-harm, which might also suggest possible other ways of self-harm, such as drug use, alcohol abuse and erratic or risky behavior. The Board found then and finds now it is a reasonable inference that a "total" disability rating would be based on the most serious of rating criteria. The parties to the November 2020 JMPR next agree the Board did not support its conclusion that the Veteran's depression in March 2004 was attributable to unemployment, but did not account for his subsequently continued depressed mood. Upon further review of the record, the Board notes the Veteran's depression, as related to PTSD or related symptoms, remained persistent. Nonetheless, the March 2004 VA examiner noted, based on the Veteran's own report, "distress/depression related to his current unemployment status." The parties also agree the Board failed to provide adequate reasons or bases to support its finding that the development of sleep apnea around 2007 suggested actual and sustained improvement, although the Veteran continued to endorse PTSD-related sleep disturbances and nightmares in 2006. Upon further review of the record, the Board notes the Veteran's reports of sleep difficulties related to PTSD remained persistent, in addition to the manifestation of sleep apnea. The parties further agree the Board did not discuss the 2004 VA examiner findings of PTSD mildly impairing leisure activities and moderately impairing activities of daily living and quality of life, while the May 2007 VA examiner found severe impairment of leisure activities and quality of life, as well as continued moderate impact on activities of daily living. The Board first notes that the May 2007 VA examiner noted that the Veteran's "physical ailments are severe and contribute substantially to his current quality of life issues." However, the VA examiner did not make specific findings the physical disorders and their effect. Nonetheless, the Veteran's further reports indicate social interaction appears only moderately affected, as the VA examiner noted appropriate interaction with others, the Veteran engages in social activities and he performs helpful and valued services to other , as shown by his report of a recent award for services as a trustee at his church. The Board does not find the distinction between mildly impaired and severely impaired leisure activities over the course of 3 years to be determinative when that distinction appears to be based only on possibly worsening symptoms of the Veteran's physical disorders. The parties also agree the Board did not discuss what, if any, impact the May 2007 VA examiner's finding of a GAF score of 50, decreased from the March 2004 VA examiner's finding of 53 had on the Board's determination that the Veteran's service-connected PTSD had actually and sustainably improved. The Board first notes that GAF scores in the range of 51-60 are assigned where there are 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, conflict with peers or coworkers). However, the Veteran reported to the March 2004 VA examiner that in fact he had many friends. The examiner noted the Veteran did not contend that his unemployment was due to the effects of a mental health disorder, but he did report a past conflict with a supervisor. Regarding social activities and leisure pursuits, the examiner, based on the Veteran's report, found "normal range." She further noted that the Veteran "stated that he spends time fishing, relaxing, serving as a trustee of his church, and engaging in other church activities. He reported that he also visits friends [and] spends time with his mother." Under "Social Functioning," she found, based on the Veteran's reports, the Veteran appropriately interacts with others, he engages in social activities, he is capable of basic activities of daily living, he is able to meet family responsibilities, and he is able to meet work demands and responsibilities. The mental status examination findings were overall normal, except for past suicidal or homicidal ideation without plan or intent, panic attacks one or twice a month, likely trauma related, frequently of an hour's duration and reported as very distressing and "very uncomfortable" and depression related to unemployment, but without sad mood, low energy and hopelessness. As stated, the May 2007 VA examiner assigned a GAF score of 50. A score of 41-50 is assigned where there are 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). The May 2007 VA examiner found the Veteran's subjective complaints did not include suicidal ideation, he reported regular interactions and good, close family relationships, but with some arguments with his wife. Regarding work, he reported his medical disorders other than PTSD preclude work; otherwise if it were just PTSD, rather than preclude, it would only "complicate" his ability to work. He further reported he had worked for 24 years for the United States Postal Service, then retired. He reported his social life as self-isolation, but the May 2007 VA examiner, based on the Veteran's further reports, noted he also appropriately interacts with others and engages in social activities and, as already stated, he received a recent award for services as a trustee at his church; he is capable of basic activities of daily living and he is able to meet family responsibilities. Mental status examination results show overall normal findings, except for "the Veteran's mood is depressed to a moderate degree, with irritability... and there is sleep impairment of PTSD-induced insomnia complicated by possible sleep apnea." Thus, a GAF score of 50, indicating by way of example suicidal ideation, severe obsessional rituals, frequent shoplifting, no friends and unable to keep a job is not borne out by that day's interview and examination. From the above array of findings, in either examination, when compared to the GAF-indicated typical symptoms, either GAF score demonstrates a symptomatology more severe than the symptoms displayed or reported by the Veteran during each examination. Although in its time acknowledged to be a useful diagnostic tool, in the instant VA examinations, the Board finds that the GAF scores were not an accurate representation of the symptoms of the Veteran's psychiatric disorder and are of limited probative value for the purposes of adjudication of the issue of the propriety of the reduction to 50 percent. The parties to the November 2020 JMPR lastly agree that "the Board shall also consider and discuss whether, notwithstanding a less than 100 percent disability rating for service-connected PTSD, that condition precluded substantially gainful employment such that [the Veteran] may be entitled to SMC pursuant to § 1114 (s)." In support of this concern, the JMPR notes an August 2004 VA PTSD treatment examination reflecting the Veteran had not worked since April 2003 because of intrusiveness of symptoms; a June 2008 VA report of contact indicating that PTSD was the reason the Veteran could not work; a February 2009 VA Form 21-4138 reflecting that PTSD "caused [the Veteran] to react spontaneously in a negative manner to personnel and/or management regarding work and performance;" and a VA Form 9 wherein the Veteran explicitly contended that he was unemployable because of PTSD, even if he were to be rated at less than 100 percent. The Board notes, as shown in the above discussion, the Veteran specifically reported in the March 2004 VA examination that his unemployment was not due to the effects of his mental disorder. Moreover, in the May 2007 VA examination, the Veteran reported his 24 uninterrupted years of employment in the United States Postal Service, leaving in 1996 when he retired. It was further indicated that his "medical disorders," preclude work and, without those disorders, PTSD would merely "complicate" his ability to work, not preclude it. Moreover, the Veteran's assertion in the statement accompanying his August 2010 Veterans Appeals Form 9 that, even if not rated at 100 percent, he is still unemployable, is inconsistent with his own reports on the 2 VA examinations on which the March 2008 rating decision to reduce SMC benefits is based. The Veteran's reports and the VA examiners' findings in those examinations do not support a further finding of PTSD at less than a total rating having precluded substantially gainful employment and, as such, warranting full entitlement to SMC benefits under 38 U.S.C. § 1114 (s). For the foregoing reasons and based on the objective psychiatric evidence, the Board finds the preponderance of the evidence supports the propriety of the reduction of the disability evaluation from 100 percent to 50 percent, effective June 1, 2008, for PTSD, to include a reduction of SMC benefits. MICHAEL D. LYON Veterans Law Judge Board of Veterans' Appeals Attorney for the Board P. Franke, 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.