Citation Nr: 22015267 Decision Date: 03/16/22 Archive Date: 03/16/22 DOCKET NO. 15-39 691 DATE: March 16, 2022 ORDER An effective date prior to March 22, 2011, for the award of service connection for posttraumatic stress disorder (PTSD) is denied. An initial rating in excess of 70 percent prior to December 13, 2013, and in excess of 50 percent as of March 28, 2014, for PTSD is denied. REMANDED Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is remanded. FINDINGS OF FACT 1. On February 24, 1986, VA received the Veteran's original claim for service connection for a nervous condition and PTSD. 2. In a final rating decision issued in September 1986, the Agency of Original Jurisdiction (AOJ) denied service connection for a nervous condition, characterized as anxiety reaction, and PTSD. 3. On January 30, 1990, VA received the Veteran's application to reopen his previously denied claim for service connection for a nervous condition and PTSD. 4. In a final rating decision issued in June 1990, the AOJ determined that new and material evidence had not been received in order to reopen a claim of entitlement to service connection for a nervous condition, characterized as anxiety reaction, and PTSD. 5. On March 22, 2011, VA received the Veteran's most recent application to reopen his previously denied claim for service connection for PTSD. 6. Prior to December 13, 2013, the Veteran's PTSD was manifested by psychiatric symptomatology resulting in occupational and social impairment with deficiencies in most areas, without more severe manifestations that more nearly approximate total occupational and social impairment. 7. As of March 28, 2014, the Veteran's PTSD is 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. CONCLUSIONS OF LAW 1. The criteria for an effective date prior to March 22, 2011, for the award of service connection for PTSD have not been met. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. 2. The criteria for an initial rating in excess of 70 percent prior to December 13, 2013, and in excess of 50 percent as of March 28, 2014, 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 FINDINGS AND CONCLUSIONS The Veteran served on active duty from February 1968 to September 1971. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision issued in September 2013 by a Department of Veterans Affairs (VA) Regional Office. In April 2019, the Veteran and his spouse testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the record. In May 2019 and October 2020, the Board remanded the case for additional development. In a February 2021 decision, the Board denied an effective date prior to March 22, 2011, for the award of service connection for PTSD, granted an initial 70 percent rating, but no higher, for PTSD prior to December 13, 2013, and denied an initial rating in excess of 50 percent for PTSD as of March 28, 2014. The Veteran appealed such decision to the United States Court of Appeals for Veterans Claims (Court) and, in October 2021, the Court granted a Joint Motion for Partial Remand (JMPR), which vacated and remanded the Board's decision to the extent that it denied an effective date prior to March 22, 2011, for the award of service connection for PTSD, denied an initial rating in excess of 70 percent for PTSD prior to December 13, 2013, and denied an initial rating in excess of 50 percent for PTSD as of March 28, 2014. The case now returns for further appellate review. In December 2021, the Veteran, through his representative, submitted additional evidence for consideration in his appeal. 38 U.S.C. § 7105(e)(1) (2018). In its prior remands, the Board found that the Veteran raised the issue of whether there is clear and unmistakable error (CUE) in the September 1986 rating decision that originally denied service connection for a nervous condition (anxiety reaction and PTSD) in his October 2015 substantive appeal and during his April 2019 Board hearing. Accordingly, the issue was referred to the AOJ for appropriate action. In an October 2020 rating decision issued under the modernized appeals system known as the Appeals Modernization Act (AMA), the AOJ denied the CUE claim and, in December 2020, the Veteran entered a Decision Review Request: Board Appeal (Notice of Disagreement) (VA Form 10182). While the Veteran's representative has argued that the CUE claim should be adjudicated as part of the earlier effective date claim currently before the Board in the legacy system, such issue is a separate matter and has been appealed under the AMA. Bowen v. Shinseki, 25 Vet. App. 250, 254 (2012). In this regard, an assertion of CUE is a motion or a request, not a theory of entitlement that can be considered part of another claim. See, e.g., Hillyard v. Shinseki, 24 Vet. App. 343, 355 (2011). Each wholly distinct and different CUE theory underlying a request for revision is a separate matter that must be adjudicated by the AOJ in the first instance and appealed to the Board; otherwise, the Board lacks jurisdiction over the merits of the matter. Jarrell v. Nicholson, 20 Vet. App. 326, 334 (2006). Moreover, jurisdiction over an earlier effective date appeal does not confer jurisdiction over an allegation of CUE in a prior final rating decision. Phillips v. Brown, 10 Vet. App. 25, 33 (1997). In this regard, while the Board recognizes that prior decisions indicated that the Veteran's CUE and earlier effective date claims were "inextricably intertwined," such distinction was applied in error. In this regard, the outcome of the Veteran's appeal of the effective date assigned for his PTSD is not dependent on the outcome of any request for revision of an earlier decision on the basis of CUE. Similarly, adjudication of his earlier effective date claim does not preclude a successful collateral attack on the earlier decision on the basis of CUE. Indeed, the Court has found that such issues are not inextricably related, and has itself bifurcated and separately adjudicated the issues of entitlement to an earlier effective date and CUE based on similar facts. Phillips v. Brown, 10 Vet. App. 25, 33 (1997); Canady v. Nicholson, 20 Vet. App. 393, 402 (2006). Therefore, such issues are not inextricably intertwined, and the Veteran's CUE claim will be addressed in a separate Board decision issued at a later date, if otherwise in order. Additionally, in consideration of the JMPR and the Veteran's reports regarding the impact that his PTSD has on his employability, the Board has assumed jurisdiction over the issue of entitlement to a TDIU as part and parcel of his initial rating claim. Rice v. Shinseki, 22 Vet. App. 447 (2009). 1. Entitlement to an effective date prior to March 22, 2011, for the award of service connection for PTSD. The Veteran argues that an effective date prior to March 22, 2011, for the award of service connection for PTSD is warranted. Specifically, at the April 2019 Board hearing, he contended that the effective date should be February 24, 1986, the date his original claim was received as he believed the AOJ erred in initially denying his claim for service connection for a nervous condition/PTSD in a September 1986 rating decision. Here, the Veteran indicated that the AOJ committed an outcome-determinative error by concluding that he was not awarded any combat medals as his DD Form 214 reflects he was the recipient of the Army Commendation Medal and/or Air Medal. In this regard, the Board again notes that his claim for revision or reversal of the September 1986 rating decision based on CUE will be separately adjudicated. In the alternative, in a December 2020 written correspondence, the Veteran, through his representative, stated that the effective date should be February 24, 1986, based upon application of 38 C.F.R. § 3.156(c). In this regard, the Board notes that the statutory and regulatory guidelines for the determination of an effective of an award of disability compensation are set forth in 38 U.S.C. § 5110 and 38 C.F.R. § 3.400. Except as otherwise provided, the effective date for a grant of service connection is the day after separation from service or date entitlement arose, if claim is received within one year of separation from service; otherwise, the date of receipt of claim, or the date entitlement arose, whichever is later. 38 U.S.C. § 5110; 38 C.F.R. § 3.400(b)(2)(i). Under 38 C.F.R. § 3.400(q)(2) and (r), the effective date based on new and material evidence other than service department records received after the final disallowance is the date of receipt of the new claim or the date entitlement arose, whichever is later. In the instant case, on February 24, 1986, VA received the Veteran's original claim for service connection for a nervous condition and PTSD. In such claim, he reported that he had an emergency admission for a nervous condition and was informed that he had PTSD at the VA Medical Center (VAMC) in February 1986. Thereafter, in a September 1986 rating decision, the AOJ considered the Veteran's service records (which, per a review of the file, included his service personnel records (SPRs) and service treatment records (STRs)), VA treatment records, and an August 1986 VA examination report, and denied service connection for a nervous condition, characterized as anxiety reaction, and PTSD. Specifically, the AOJ found that, while the Veteran's SPRs reflected that he served approximately 11 months in the Republic of Vietnam as a flight operation coordinator, no combat medals were awarded. The AOJ further found that, while the Veteran's VA treatment records included diagnoses of PTSD and generalized anxiety disorder in February 1986, the August 1986 VA examiner opined that sufficient material was not presented to support a PTSD diagnosis. Rather, the examiner noted a diagnosis of anxiety reaction, and determined that the Veteran's in-service duties were relatively secure. Lastly, the AOJ noted that the Veteran's STRs were negative for any complaints or treatment for a nervous disorder. While the record does not contain a copy of a notice letter sent to the Veteran in connection with the rating decision, and he, through his representative, alleges that the "presumption of regularity" should not attach to the September 1986 rating decision, the Board finds such argument to be without merit. In this regard, at the time of the September 1986 rating decision, computer generated notification letters, which contained various language based on the code(s) input into the system by the rating specialist, were permitted. Specifically, at such time, VA's Adjudication Procedures Manual, M21-1 (Manual), indicated that the computer generated notification letters were produced on a nightly basis and were thereafter printed with copies going to the claimant, power of attorney, and if required, to the claims folder. See M21-1 (Archived), Part V, Chap. 5, Sub. II, 5.02, b-c. In regard to the content to such letters, 38 C.F.R. § 3.103(e) (1986) specified that notice of a decision would include the reason for the decision, the date it was effectuated, the right to a hearing, and the right to initiate an appeal by filling a Notice of Disagreement. Here, the Board notes that a "presumption of regularity" attaches to the official acts of public officers. See, e.g., Marciniak v. Brown, 10 Vet. App. 198, 200 (1997), aff'd sub nom. Marciniak v. West, 168 F.3d 1322 (Fed. Cir. 1998); Chute v. Derwinski, 1 Vet. App. 352, 353 (1991). That is to say, there is a presumption, rebuttable only by "clear evidence to the contrary," that public officers have properly discharged their official duties. Ashely v. Derwinski, 2 Vet. App. 307, 308-309 (1992). In Kuo v. Derwinski, 2 Vet. App. 662, 665 (1992), the United States Court of Veterans Appeals held, citing Ashley, supra, that "[i]n the absence of clear [underline added] evidence to the contrary,... it must be presumed that the Secretary properly discharged his official duties and mailed the letter to appellant in care of his representative in the normal course of business." Accordingly, although a copy of the actual notification letter is not of record, pursuant to the presumption of regularity attending the official acts of public officers, it must be concluded that the Veteran was appropriately notified of the September 1986 rating decision at his current address of record, and that notice was in compliance with the requirements of 38 C.F.R. § 3.103(e) (1986). Dolan v. Brown, 9 Vet. App. 358, 362 (1996). Here, the Board observes that a VA Form 21-8947 (Compensation and Pension Award), dated in September 1986, reflecting disallowance as the disability was not due to service, contained the Veteran's most recent address then of record and there is nothing of record to show that the notification letter was returned to the AOJ as undeliverable. The Veteran nor his representative have provided clear evidence to rebut the presumption of regularity that VA personnel did not properly discharge their office duties in compliance with the regulations, statutes, and procedures in effect at the time of the September 1986 rating decision. Any assertion that the Veteran did not receive the September 1986 computer-generated denial letter and/or such letter was not produced does not rise to the level of "clear evidence to the contrary," which is required to rebut the presumption of regularity. Clarke v. Nicholson, 21 Vet. App. 130, 133 (2007). Further, the fact that the claims file did not contain a copy of the actual notification letter that was mailed to the Veteran also does not overcome the presumption of regularity as the Manual at such time indicated that notification letters were only included in the claims file "if required." Significantly, the Board observes that the September 1986 rating decision indicates that notification of the denial of service connection for a nervous condition (anxiety reaction and PTSD) was given to the Veteran's representative at the time, the Georgia Department of Veterans Service (SDVS), as the bottom of the rating decision includes the initials of the representative. Here, the Board notes that a March 1986 VA Form 21-6789 (Deferred or Confirmed Rating Decision) in relation to the Veteran's original claim for service connection for a nervous condition and PTSD consistently reflects that the Veteran was being represented by SDVS. Thus, despite receiving notice of the September 1986 rating decision, the Veteran did not enter a notice of disagreement as to the denial of service connection for his claimed psychiatric disorder. Furthermore, no new and material evidence was physically or constructively associated with the record within one year of the issuance of such decision and, as will be discussed further herein, no relevant service department records have since been received. Therefore, the September 1986 rating decision is final. 38 U.S.C. § 4005(c) (1982) [38 U.S.C. § 7105(c) (2012)]; 38 C.F.R. §§ 3.104, 19.129, 19.192 (1986) [38 C.F.R. §§ 3.104, 3.156, 20.302, 20.1103 (2020)]. VA subsequently received the Veteran's application to reopen his claim for service connection for a nervous condition and PTSD in January 1990. However, in a March 1990 rating decision, the AOJ found that new and material evidence had not been received in order to reopen the Veteran's claim for service connection for a nervous condition, characterized as anxiety reaction, and PTSD. In June 1990, the Veteran was advised of the decision and his appellate rights, but he did not enter a notice of disagreement with such decision. Further, no new and material evidence was physically or constructively associated with the record within one year of the issuance of such decision and, as will be discussed further herein, no relevant service department records have since been received. Therefore, the June 1990 rating decision is final. 38 U.S.C. § 4005(c) (1988) [38 U.S.C. § 7105(c) (2012)]; 38 C.F.R. §§ 3.104, 19.129, 19.192 (1989) [38 C.F.R. §§ 3.104, 3.156, 20.302, 20.1103 (2020)]. Following the issuance of the most recent final denial in June 1990, no further communication was received from the Veteran regarding a claim for service connection for a nervous condition and/or PTSD until March 22, 2011, when VA received his most recent application to reopen his claim for service connection for PTSD. In connection with his application, he, for the first time, provided detailed stressor statements. Specifically, the Veteran indicated that he experienced a rocket attack in August 1970 while stationed in the Republic of Vietnam when a rocket blew up an unprotected tent in his compound and, after 30 years of blocking names, he was able to recall that SP5 Robert (Ronald) Lee Young and SP5 John Frederick Werner were lost in the tent. He further indicated that friends he was stationed with in Vietnam (Chief Warrant Officer Dennis James Brault and Chief Warrant Officer Douglas Silvio Vergamini) were lost when their helicopter was shot down while on a mission in June 1970. Additionally, the Veteran submitted information from "The Virtual Wall" website that reflected that Ronald Lee Young died in August 1970 as a result of "artillery, rocket, or mortar." He further submitted an excerpt from the "Sky Trooper Book of Honor" through the 1st Cavalry Division Association website that indicated that John Frederick Werner (August 1970), Dennis James Brault (June 1970), and Douglas Silvio Vergamini (June 1970) had passed away. In this regard, the Board notes that, while the Veteran, through his representative, alleges that 38 C.F.R. § 3.156(c) requires that his original February 1986 claim for service connection for a nervous condition and PTSD be reconsidered in light of the receipt of new relevant service department records, the Board finds such argument to be without merit. In this regard, 38 C.F.R. § 3.156(c)(1) provides that, at any time after VA issues a decision on a claim, if it receives or associates with the claims file relevant official service department records that existed and had not been associated with the claims file when VA first decided the claim, VA will reconsider the claim. Such records include service records that are related to a claimed in-service event, injury, or disease. This regulation does not apply to records that VA could not have obtained when it decided the claim because they did not exist or because the claimant failed to provide sufficient information for VA to identify and obtain the records. Id. at (c)(2). An award made based all or in part on the records identified by paragraph (c)(1) is effective on the date entitlement arose or the date VA received the previously denied claim, whichever is later, or such other date as may be authorized by the provisions of this part applicable to the previously denied claim. Id. at (c)(3). Such regulation essentially establishes that, where an initial claim is denied due to the lack of evidence of an in-service event, but is later granted based all or in part on subsequently acquired service records establishing the in-service event and a nexus between the in-service event and the current disability, the claimant is entitled to a retroactive evaluation of the disability to assess the proper effective date, which would be the date of the original claim or the date entitlement otherwise arose, whichever is later. Id.; Vigil v. Peake, 22 Vet. App. 63, 66-67 (2008). In this sense, the original claim is not reopened, rather, it is reconsidered and such serves as the date of the claim and the earliest date for which benefits may be granted. Importantly, the U.S. Court of Appeals for the Federal Circuit (Federal Circuit) found that "[s]ection 3.156(c) only applies 'when VA receives official service department records that were unavailable at the time that VA previously decided a claim for benefits and those records lead VA to award a benefit that was not granted in the previous decision.' New and Material Evidence, 70 Fed. Reg. at 35,388." Blubaugh v. McDonald, 773 F.3d. 1310 (Fed. Cir. 2014). More recently, the Federal Circuit has accepted that the term "relevant official service department record" in 38 C.F.R. § 3.156(c)(1) means "noncumulative and pertinent to the matter at issue in the case." Kisor v. Shulkin, 869 F.3d 1360 (Fed. Cir. 2017). In the instant case, the record reflects that the Veteran's DD Form 214 (Armed Forces of the United States Report of Transfer or Discharge), SPRs, and STRs were on file at the time of the September 1986 rating decision and reflected his service in the Republic of Vietnam, his military occupational specialties, his assigned units, and the receipt of various awards and decorations. In this regard, the Board notes that, in October 2020 and December 2020, the Veteran's representative argued that the Veteran's complete SPRs have not been obtained; however, finds such argument to be without merit. In this regard, a review of the Veteran's SPRs reflects that such include, in addition to the aforementioned information, documentation of an Article 15, performance evaluations, and the basis of his awards, to specifically include the Army Commendation Medal and Air Medal. There is no indication that such records are incomplete and, while the Veteran's representative indicated that the basis of the Veteran's awards are missing, such is an inaccurate statement. Consequently, the Board finds that, as the Veteran's complete SPRs are on file, no further action is necessary in such regard. Further, as noted previously, the Veteran's SPRs revealed that he served in the Republic of Vietnam as a flight operation coordinator and was the recipient of the Army Commendation Medal for meritorious service in connection with military operations in the Republic of Vietnam and the Air Medal for meritorious achievement while participating in aerial flight in the Republic of Vietnam. However, in the September 1986 rating decision, the AOJ determined that no combat medals were awarded and the August 1986 VA examiner found that, compared to the duties of an infantryman or marine involved in ambushes, direct combat, and search and destroy missions, the Veteran's duties were relatively secure, and found insufficient evidence to diagnose PTSD. Further, he did not relate the Veteran's anxiety reaction to his military service. Therefore, more information was necessary in order to corroborate the stressors associated with the Veteran's claimed PTSD. However, he did not provide further information until the submission of his March 2011 claim (as described above). Thereafter, based on the Veteran's newly described stressors and his submission of supporting evidence from "The Virtual Wall" and the "Sky Trooper Book of Honor," the AOJ found that Ronald Lee Young was assigned to the Veteran's same unit and killed in August 1970 under hostile fire (artillery, rocket, or mortar), and the other service member from the same unit had died while the Veteran was attached to such unit. Accordingly, the AOJ determined that there was adequate evidence to corroborate the Veteran's assertions about his Vietnam experiences and conclude that he engaged in combat with the enemy. Consequently, in the September 2013 rating decision, the AOJ granted service connection for PTSD based on the Veteran's conceded stressors as a result of his detailed statements and corroborating excerpts from "The Virtual Wall" and "Sky Trooper Book of Honor." Here, there were no additional service department records that were associated with the record subsequent to the issuance of the September 1986, or June 1990, rating decision and resulted in the award of service connection for PTSD. Consequently, the AOJ assigned an effective date of March 22, 2011, the date the Veteran's most recent application to reopen his previously denied claim was received. Therefore, based on the above-stated facts and regulations, the Board finds that the correct date for the grant of service connection for PTSD is March 22, 2011, the date the Veteran's most recent application to reopen such claim was first received following the final June 1990 rating decision. 38 C.F.R. § 3.400(q)(1)(ii); (r). As such, an earlier effective date is not warranted and the Veteran's claim must be denied. 2. Entitlement to an initial rating in excess of 70 percent prior to December 13, 2013, and in excess of 50 percent as of March 28, 2014, for PTSD. Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities, found in 38 C.F.R., Part 4. 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. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise the lower rating will be assigned. 38 C.F.R. § 4.7. All benefit of the doubt will be resolved in the Veteran's favor. 38 C.F.R. § 4.3. Separate ratings can be assigned for separate periods based on the facts found - a 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's service-connected PTSD is evaluated as 70 percent disabling prior to December 13, 2013, and 50 percent disabling thereafter, exclusive of the time period where a temporary total rating has been assigned (from December 13, 2013, to March 28, 2014), stemming from March 22, 2011, the date of service connection pursuant to DC 9411. DC 9411 provides that such disability is evaluated pursuant to the General Rating Formula for Mental Disorders. See 38 C.F.R. § 4.130. In this regard, a 50 percent rating contemplates 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; impairments of short-and long-term memory; impaired judgment; impaired abstract thinking; disturbance of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships. Id. A 70 percent evaluation 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; intermittently illogical, obscure, or irrelevant speech; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work like setting); inability to establish and maintain effective relationships. Id. A 100 percent evaluation is warranted where 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. As the United States Court of Appeals for the Federal Circuit explained, 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. VazquezClaudio v. Shinseki, 713 F.3d 112, 11617 (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 117-18; 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. The Board notes that the revised DSM-5, which, among other things, eliminates Global Assessment of Functioning (GAF) scores, applies to appeals certified to the Board after August 4, 2014, as is the case here. See 79 Fed. Reg. 45, 093 (Aug, 4, 2014). Consequently, the Board will not consider the previously assigned GAF scores in determining the outcome of this case. See Golden v. Shulkin, 29 Vet. App. 221 (2018). The Board finds that an initial rating in excess of 70 percent prior to December 13, 2013, and in excess of 50 percent as of March 28, 2014, for the Veteran's PTSD is not warranted. Turning to the evidence of record, February 2011 and April 2011 VA treatment records reflect that the Veteran experienced the following symptoms: mildly depressed mood, increased irritability, poor sleep, unreasonable or excessive guilt, fatigue, and decreased concentration. He had no thoughts of death or harm to others and there were no symptoms consistent with hallucinations or delusions. Such records further indicate that the Veteran experienced nightmares; was well-groomed, appropriately dressed, and oriented; and had average insight and judgment. A March 2011 VA treatment record includes the Veteran's report that he had thoughts of suicide a number of times over the years since service; however, he had never made any plans or attempted suicide. Additional VA treatment records dated in 2011 and 2012 note that the Veteran experienced anger, depression, irritability, occupational problems, financial problems, decrease interest, anxiety, loss of sleep, isolation, and relationship problems, but denied suicidal/homicidal ideation. Such records further note that the Veteran spent time with his son. From December 13, 2013, to March 28, 2014, the Veteran was hospitalized for treatment for PTSD. At such time, he reported nightmares, flashbacks, and depression with feelings of guilt, anger, and rage. VA treatments dated from May 2014 to December 2015 reflect that the Veteran experienced trouble with sleep and dreams, and he had irritability, anxiety, panic attacks, occasional road rage, depression, and marital problems (which he was working on amending). He denied suicidal or homicidal ideation. Such records further reflect that the Veteran was adequately dressed and groomed; alert and oriented; and had normal speech, full range/constricted affect, appropriate thought content, local and goal-oriented thought process, no illusions or delusions, intact memory and concentration, and good insight and judgment. Specifically, there is no evidence that the Veteran's PTSD symptomatology results in total occupational and social impairment at any point prior to December 13, 2013. In this regard, the evidence does not demonstrate gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; or memory loss for names of close relatives, own occupation, or own name. While the Veteran has irritability and difficulty dealing with people, he has consistently maintained a relationship with his spouse and children, and kept in contact with his family. Consequently, it cannot be found that his PTSD results in total occupational and social impairment prior to December 13, 2013. Following the Veteran's hospitalization, he was afforded another VA examination in September 2015, at which time he reported that his PTSD had improved since his hospitalization. At such time, the examiner found that he had occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by continuous medication, which is consistent with a 10 percent rating under the General Rating Formula. In this regard, the Veteran reported that he had been married for 40 years and had three children. He further reported that he got along well with his spouse, kept in touch with his family, and visited his older sister occasionally. Additionally, the Veteran indicated that he was currently driving trucks for work. His symptoms included anxiety, suspiciousness, chronic sleep impairment, and mild memory loss. Behavior observations revealed that the Veteran was neatly groomed; mood was anxious with congruent affect; he was fully oriented and alert; there was no observable impairment in attention, concentration, or memory; thought processes was logical, linear, and goal-oriented; no delusions and hallucinations; judgment, insight, and impulse control were intact, and he denied present suicidal or homicidal ideation, but reported occasional past suicidal ideation without plan or intent. At the April 2019 hearing, the Veteran reported that he experienced vivid nightmares and depression, and was antisocial without any friends. He further indicated that he had difficulty with memory, focus, and concentration, and his spouse reported that he was not motivated to do anything. The Veteran also reported that he avoided crowds and had been laid off from previous jobs due to his PTSD symptoms, to include anger and resulting road rage. Similarly, the Veteran's spouse indicated that he had issues with irritability and anger, and often cried, which, in turn, affected his relationship with her and their family due to conflicts/disagreements. The Veteran underwent another VA examination in November 2019. At such time, the examiner found that he had occupational and social impairment with reduced reliability and productivity, which is consistent with a 50 percent rating under the General Rating Formula. The Veteran reported that he lived with his spouse of 42 years and had three children. He also stated that he worked as a truck driver, but had been unemployed since he had a heart attack at the beginning of the year. The Veteran's symptoms included depressed mood; anxiety; suspiciousness; chronic sleep impairment; mild memory loss; impairment of short-and long-term memory; circumstantial, circumlocutory or stereotyped speech; and disturbances of motivation and mood. VA treatment records dated in 2019 and 2020 reveal the Veteran's report that he was currently working as a truck driver/around town driver; and denied any thoughts of harm to self or others. His affect was appropriate and thought process was logical and goal-oriented. Further, he had no delusions or obsessions; denied suicidal or homicidal ideation; had no auditory, tactile, or visual hallucinations; insight/judgment was fair; memory was intact to recent and remote events; and he was alert and oriented. The Board acknowledges that, in a December 2021 private opinion, Dr. C.M. determined that the Veteran's PTSD resulted in occupational and social impairment with deficiencies in most areas due to symptoms of nightmares, flashbacks, diminished interests, detachment, constricted affect, hypervigilance, exaggerated startle response, sleep disturbance, survivor guilt, difficulty with concentration, avoidance, depressed mood, near-continuous depression affecting the ability to function independently, appropriately and effectively, disturbances of motivation and mood, difficulty in establishing and maintaining effective work and social relationships, difficulty adapting to stressful circumstances, including work or a work like setting, and suicidal ideation. However, based on the totality of the foregoing evidence, as of March 28, 2014, the Board finds that the nature, frequency, severity, and duration of the Veteran's PTSD symptomatology resulted in, at most, occupational and social impairment with reduced reliability and productivity. Here, there is no evidence that the Veteran's PTSD results in obsessional rituals which interfere with routine activities; intermittently illogical, obscure, or irrelevant speech; impaired impulse control; spatial disorientation; neglect of personal appearance and hygiene; or an inability to establish and maintain effective relationships. Furthermore, the September 2015 VA examiner opined the Veteran's PTSD resulted in occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms controlled by continuous medication, which is consistent with a 10 percent rating under the General Rating Formula, and the November 2019 VA examiner opined the Veteran's PTSD resulted in occupational and social impairment with reduced reliability and productivity, which is consistent with a 50 percent rating under the General Rating Formula. Further, as detailed above, the Veteran has never reported symptoms commensurate with a 100 percent rating, nor do any treatment records or examinations reflect such symptoms throughout the appeal period. Thus, the Board finds that, as the probative evidence of record does not show that the Veteran's PTSD resulted in occupational and social impairment with deficiencies in most areas or total occupational and social impairment as of March 28, 2014, an initial rating in excess of 50 percent for such disability is not warranted. In reaching such conclusion, the Board affords less probative weight to the December 2021 private opinion. Here, while Dr. C.M. indicated that she reviewed the Veteran's claims file, including his previous treatment records, it appears that her conclusion that the Veteran's PTSD resulted in occupational and social impairment with deficiencies in most areas is based upon the Veteran's self-reported medical history taken during a December 2021 videoconference interview. Significantly, such a finding is directly contradicted by the VA treatment records, as well as both VA examinations conducted during the appeal period. In this regard, in contrast to Dr. C.M.'s opinion, the September 2015 and November 2019 VA examiners provided narrative summarizing the Veteran's social, marital, family, occupational, educations, and medical histories. However, Dr. C.M. did not demonstrate her knowledge of the Veteran's relevant history with as much detail as the VA examiners. Here, the Board observes that Dr. C.M. cited the September 2015 VA examination findings; however, she did not note the findings from the November 2019 VA examination nor those found in the Veteran's VA treatment records. The Board is required to weigh the evidence of record, including the medical evidence, to make factual determinations. Evans v. West, 12 Vet. App. 22, 30 (1998). Given that the VA examiners provided a more thorough basis for their determinations, the Board assigns such examinations greater probative value. Additionally, while Dr. C.M. noted that the Veteran experienced from some symptoms as contemplated by a 70 percent rating, such are not shown to be of a nature, frequency, duration, and severity as to result in social and occupational impairment with deficiencies in most areas. Here, while she indicated that the Veteran had near-continuous depression which affected his ability to function independently, appropriately and effectively, there is no indication of such symptomatology elsewhere in the record during the appeal period, and neither the Veteran nor medical evidence explicate that his ability to function was significantly reduced. Further, while Dr. C.M. indicated that the Veteran had difficulty in adapting to stressful circumstances (including work or a work like setting), he had been able to maintain employment as a truck driver for the majority of the appeal period and, although he did not handle stress well, he noted that he had gotten better at avoiding stressful situations. Moreover, while Dr. C.M. indicated that the Veteran endorsed suicidal ideation, the evidence at such time suggests that he did not endorse present suicidal ideation, but past suicidal ideation as indicated by his statement: "I've struggled with suicidal ideation ..." Such endorsement is consistent with the Veteran's 70 percent rating for PTSD prior to December 13, 2013, and his temporary total rating assigned from such date to March 28, 2014. Notably, the Veteran predominantly denied suicidal ideation thereafter. The remainder of the Veteran's psychiatric symptoms noted in the December 2021 private opinion are explicitly contemplated by the rating criteria for a 10, 30, or 50 percent rating under the General Rating Formula. In reaching its conclusions, the Board acknowledges the Veteran's belief that his symptoms related to his PTSD are more severe than as reflected by the currently assigned ratings. The Board must consider the entire evidence of record when analyzing the criteria laid out in the rating schedule. While the Board recognizes that the Veteran is competent to describe his symptomatology, he is not competent to provide an opinion regarding the severity of his symptomatology in accordance with the rating criteria. Woehlaert v. Nicholson, 21 Vet. App. 456 (2007) (explaining that while the claimant is competent in certain situations to provide a diagnosis of a simple condition such as a broken leg or varicose veins, the claimant is not competent to provide evidence as to more complex medical question). The Board finds the medical evidence in which professionals with medical expertise examined the Veteran in regard to his PTSD, acknowledged his reported symptoms, and described the manifestations of such disabilities in light of the rating criteria to be more persuasive than his own reports regarding the severity of such disabilities. The Board has considered whether additional staged ratings under Fenderson, supra, are appropriate for the Veteran's PTSD; however, the Board finds that his symptomatology has been stable throughout the periods on appeal. Therefore, assigning additional staged ratings for such disability 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 his initial rating claim. Doucette v. Shulkin, 28 Vet. App. 366 (2017). In conclusion, the Board finds that higher initial ratings for the Veteran's PTSD are not warranted. In reaching such determination, the Board has considered the applicability of the benefit of the doubt doctrine; however, as the evidence of record persuasively weighs against the Veteran's claim, the benefit of the doubt doctrine is not applicable in the instant appeal and his initial rating claim must be denied. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. REASONS FOR REMAND 4. Entitlement to a TDIU. As noted in the Introduction, a claim for a TDIU has been raised as part and parcel of the initial rating claim adjudicated herein. See Rice, 22 Vet. App. At 453-54. Therefore, on remand, the Veteran should be requested to complete and return VA Form 21-8940 (Veteran's Application for Increased Compensation Based on Unemployability). Thereafter, the AOJ should review the record and conduct any indicated development deemed necessary for the adjudication of such claim. The matter is REMANDED for the following action: The Veteran should be requested to complete and return VA Form 21-8940 (Veteran's Application for Increased Compensation Based on Unemployability). Thereafter, the AOJ should review the record and conduct any indicated development deemed necessary for the adjudication of such claim. A. JAEGER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Koria B. Stanton, 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.