Citation NR: 9801600 Decision Date: 01/21/98 Archive Date: 01/28/98 DOCKET NO. 92-21 649 ) DATE ) ) On appeal from the Department of Veterans Affairs (VA) Regional (RO) Office in Houston, Texas THE ISSUE 1. Entitlement to an evaluation in excess of 30 percent prior to August 7, 1991. 2. Entitlement to an evaluation in excess of 50 percent for post-traumatic stress disorder (PTSD). REPRESENTATION Appellant represented by: Disabled American Veterans WITNESSES AT HEARING ON APPEAL Appellant and spouse ATTORNEY FOR THE BOARD G. Wm. Thompson INTRODUCTION The veteran had active military service from November 1942, to October 1943. He had overseas duty from May to June 1943. The veteran raised the issue of an increased rating for his service-psychiatric disorder in March 1990. By rating action in August 1990, the 10 percent evaluation for anxiety was increased to 30 percent, effective from September 14, 1989. A rating action in December 1991 service connected tension headaches, secondary to anxiety, confirming and continuing the 30 percent evaluation for anxiety with tension headaches. In a June 1992 rating action the evaluation for anxiety with tension headaches was increased to 50 percent effective from August 7, 1991. An August 1996 rating action granted service connection for PTSD (previously diagnosed and evaluated as anxiety disorder), confirming and continuing the 50 percent evaluation, and established a separate rating for tension headaches, rated 10 percent from September 14, 1989. An RO decision awarding a higher rating, but less that maximum available benefit, does not abrogate the pending appeal. Ab v. Brown, Vet. App. 35 (1993). The issue of entitlement to an increased evaluation for PTSD, evaluated as 50 percent disabling was previously before the Board and remanded for additional development in September 1994. The case has been returned to the Board for further appellate consideration. The issue of an increased rating for the service-connected psychiatric disorder has been continuously pursued since March 1990, and the changes in the rating in the course of this appeal require that the increased rating issue be framed to show the change. In September 1993 the veteran raised the issue of entitlement to service connection for tobacco related respiratory disability. In October 1994 he was informed that this issue was deferred, pending new regulations. The RO should advise the veteran of the status of this claim. The veteran raised the issue of entitlement to a total rating based on individual unemployability due to service-connected disability, in December 1996. A rating action in August 1997, in addition to other determinations, denied a total rating based on individual unemployability, and the veteran was informed of the denial and his appellate rights in September 1997. There is no record of a notice of disagreement (NOD) for this issue (or the other August 1997 determinations), it is not intertwined with any issue on appeal, and it will not be considered by the Board at this time. 38 C.F.R. § 20.200 (1996). In the course of this appeal the veteran filed a claim for service connection for tinnitus secondary to service- connected disability. He filed a Notice of Disagreement in October 1996, a Statement of the Case (SOC) was issued in February 1997, and a Supplemental Statement of the Case (SSOC) in June 1997; however, there is no record of a substantive appeal for this issue. Absent the substantive appeal, this issue is not before the Board. 38 C.F.R. § 20.200, 20.202 (1996). In a written communication to the RO in October 1996, the veteran raised the issue of entitlement to an earlier effective date for an increased rating for PTSD. The Board finds that this claim is not intertwined with the issues on appeal, has not been developed for appeal and will not be considered by the Board at this time. The RO’s attention is directed to the claim for action deemed appropriate. It appears that J. Bergland, M.D., in a statement dated in February 1997, raised on behalf of the veteran, the issues of service connection for high blood pressure, esophageal reflux and irritable bowel syndrome, “all related to his sense of anxiety.” The RO should contact Dr. Bergland in this regard, to determine whether he feels that such physical disabilities are causally related to the veteran’s service-connected psychoneurosis, or if they are aggravated thereby. Any response from the good doctor should be accompanied by appropriate documentation. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that the RO erred in not finding that the evidence of record supports an increased evaluation for his service-connected post-traumatic stress disorder. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991 & Supp. 1997), has reviewed and considered all of the evidence and material of record in the veteran's claims files. Based on its review of the relevant evidence in this matter, and for the following reasons and bases, it is the decision of the Board that the preponderance of the evidence is against an evaluation in excess of 30 percent prior to August 7, 1991, and an evaluation in excess of 50 percent rating for the service-connected psychoneurosis. FINDINGS OF FACT 1. The pertinent evidence prior to August 7, 1991, for the service-connected psychoneurosis, shows no more than moderate disability; the veteran was able to work, speech was normal, effect was not flattened, and there was no impairment of long term memory, judgment, abstract thinking, or motivation. 2. The service-connected PTSD currently is principally manifested by sleep problems, and subjective reports of nightmares and flashbacks, with anxiety and moderate depression; no more than considerable social and industrial impairment is shown under the criteria in effect prior to November 7, 1996 and no more than occupational and social impairment with reduced reliability and productivity is shown under the criteria in effect since November 7, 1996. CONCLUSIONS OF LAW 1. An evaluation in excess of 30 percent for PTSD, prior to August 7, 1991, is not warranted. 38 U.S.C.A. §§ 1155, 5107(a) (West 1991 & Supp. 1997); 38 C.F.R. § 4.130, Diagnostic Code 9411 (1996). 2. An evaluation in excess of 50 percent for PTSD is not warranted. 38 U.S.C.A. §§ 1155, 5107(a) (West 1991 & Supp. 1997); 38 C.F.R. §§ 4.130, Diagnostic Code 9411 (1996). REASONS AND BASES FOR FINDINGS AND CONCLUSION GENERALLY APPLICABLE LAW AND REGULATIONS An allegation of increased disability establishes a well- grounded claim. Proscelle v. Derwinski, 2 Vet. App. 629 (1992) When entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary concern. Although a rating specialist is directed to review the recorded history of a disability in order to make a more accurate evaluation, see 38 C.F.R. § 4.2, the regulations do not give past medical reports precedence over current findings. Francisco v. Brown, 7 Vet. App. 55 (1994). Where a law or regulation changes after the claim has been filed or reopened before administrative or judicial process has been concluded, the version most favorable to the veteran applies unless congress provided otherwise or permitted the VA Secretary to do otherwise and the Secretary did so. Karnas v. Derwinski, 1 Vet. App. 308, 311 (1991); Marcoux v. Brown, 10 Vet. App. 3 (1996). Compensation may not be awarded or increased, however, under any Act or administrative issue prior to the effective date of that Act or administrative issue. 38 U.S.C.A. § 5110(g) (West 1991); DeSousa v. Gober, No. 96-001 (U.S. Vet. App. October 31, 1997). In rating a psychoneurotic disorder, when the attitudes of all contacts except the most intimate are so adversely affected as to result in virtual isolation in the community, and totally incapacitating psychoneurotic symptoms bordering on gross repudiation of reality with disturbed thought or behavioral processes associated with almost all daily activities such as fantasy, confusion, panic and explosions of aggressive energy result in profound retreat from mature behavior, with demonstrably inability to obtain or retain employment, a 100 percent rating is for assignment. Where the ability to establish and maintain effective or favorable relationships with people is severely impaired, and the psychoneurotic symptoms are of such severity and persistence that there is severe impairment in the ability to obtain or retain employment, a 70 percent rating is warranted. Where the ability to establish and maintain effective or favorable relationships with people is considerably impaired, and by reason of psychoneurotic symptoms the reliability, flexibility and efficiency levels are so reduced as to result in considerable industrial impairment, a 50 percent rating is assigned. Where there is definite impairment in the ability to establish or maintain effective and wholesome relationships with people, and the psychoneurotic symptoms result in such reduction in initiative, flexibility, efficiency and reliability levels as to produce definite industrial impairment, a 30 percent evaluation is in order. 38 C.F.R. Part 4, Diagnostic Code 9400. ). There are additional guidelines for evaluating PTSD, i.e., social impairment per se will not be used as the sole basis for any specific percentage evaluation, but is of value only in substantiating the degree of disability based on all of the findings. 38 C.F.R. § 4.132, Note (1). (as in effect prior to November 7, 1996). In Hood v. Brown, 4 Vet. App. 301 (1993), the Court of Veterans Appeals stated that the term "definite" in 38 C.F.R. § 4.132 was "qualitative" in character, whereas the other terms were "quantitative” in character, and invited the Board to "construe" the term "definite" in a manner that would quantify the degree of impairment for purposes of meeting the statutory requirement that the Board articulate "reasons or bases" for its decision 38 U.S.C.A. § 7104(D)(1)(West 1991).In a precedent opinion, dated November 9, 1993, the General Counsel of the VA concluded that "definite" is to be construed as "distinct, unambiguous, and moderately large in degree." It represents a degree of social and industrial inadaptability that is "more than moderate but less than rather large." O.G.C. Prec. 9-93 (Nov. 9, 1993). The Board is bound by this interpretation of the term "definite." 38 U.S.C. § 7104(c). 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, warrant a 100 evaluation. When 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, a 70 percent evaluation is assigned. Occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short-and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships, warrant a 50 percent rating. 38 C.F.R. § 4.130, Diagnostic Code 9411 (Effective November 7, 1996). It is the defined and consistently applied policy of the Department of Veterans Affairs to administer the law under a broad interpretation, consistent, however, with the facts shown in every case. When, after careful consideration of all procurable and assembled data, a reasonable doubt arises regarding service origin, the degree of disability, or any other point, such doubt will be resolved in favor of the claimant. By reasonable doubt is meant one which exists because of an approximate balance of positive and negative evidence which does not satisfactorily prove or disprove the claim. It is a substantial doubt and one within the range of probability as distinguished from pure speculation or remote possibility. It is not a means of reconciling actual conflict or a contradiction in the evidence; the claimant is required to submit evidence sufficient to justify a belief in a fair and impartial mind that the claim is well grounded. Mere suspicion or doubt as to the truth of any statements submitted, as distinguished from impeachment or contradiction by evidence or known facts, is not justifiable basis for denying the application of the reasonable doubt doctrine if the entire, complete record otherwise warrants invoking this doctrine. The reasonable doubt doctrine is also applicable even in the absence of official records, particularly if the basic incident allegedly arose under combat, or similarly strenuous conditions, and is consistent with the probable results of such known hardships. 38 C.F.R. §§ 3.102, 4.3 (1996) BACKGROUND When the veteran entered service in November 1942, he reported a birth date of November [redacted], 1923. Medical records dated in February and March 1943 showed the veteran to be 19 years old. A disposition board proceeding for the 12th General Hospital, Mediterranean Base Section, in June 1943, under the heading “Brief medical history of the case:” noted that the veteran stated that he had headaches “‘all his life,’” worse during the past 2 months. He had been in North Africa 3 months, was in a combat M.P. (military police) group, subject to bombing and strafing, but not in actual contact with the enemy. He was intolerant to noises, tense, slept poorly, and there was a history of broken home, child- hood nail biting and fear of the dark. The diagnosis was psychoneurosis, anxiety state, acute, battle-incurred, in a predisposed individual. He was to be evacuated to the zone of the interior. Service medical records associated with the veteran’s admission to a medical facility in the United States, in August 1943, record the veteran’s age as 22 and his date of birth as November [redacted], 1920. The history provided by the veteran was that, while riding a motorcycle as a messenger in Tunisia on May 13, 1943, a Messerschmitt strafed part of the convoy. “He jumped off his motorcycle and a 20 mm shell hit the motorcycle. He became so frightened he couldn’t move.” The veteran was picked up by his buddies and returned to the company. He felt jumpy for about 8 hours and stayed in bed. He returned to duty but couldn’t stand the sound of airplanes, did not sleep well and had frontal headaches. He was hospitalized beginning in June 1943, finally being transferred to a medical facility in the United States. Other information recorded while hospitalized from August to October 1943 included a personal history wherein the veteran reported that he when his parents divorced he stayed with his father, completed high school at age 17, and that he had headaches since the age of 12 years. When discharged in October 1943, the diagnosis was psychoneurosis, anxiety state, chronic, moderately severe. The veteran’s original application for disability benefits in October 1943, noted chronic sinusitis in service, and a birth year of 1920. The veteran was examined by the VA in December 1943, and a history was given compatible with that recorded in service in August 1943 . The veteran reported that he had frequent frontal headaches but not as serious and not as frequent as in Africa. He denied nightmares, and believed he was calmer now and able to do some work. The diagnosis was psychoneurosis, anxiety state. A rating action in January 1944 granted service connection for psychoneurosis anxiety, with a 50 percent evaluation. A social survey, dated in November 1944, noted that the veteran had been traveling around the country, working various jobs, and experienced 2 episodes of “blackouts.” He was interested in pursuing art on a commercial basis, and believed that his nomadic life fit in with an artist’s life. He attributed his depression to family conflicts. He reported being raised by a strict authoritative aunt, and he still expressed some conflict over her discipline in the past. He was trying very hard to live the life of an artist. He indicated he had no trouble sleeping. When examined by the VA in April 1945, the veteran reported that he was “kind of a wild child,” running away from home at ages 12 and 14, and being frequently truant from school. He interrupted his high school at age 16 to go west to live with his father. In regard to his military history, it was recorded that he had a fraudulent enlistment and subsequent misstatements regard his age and birth date at different examinations. The veteran stated that he had always been nervous and bashful, resented authority, liked to do as he pleased, and had his own way about most things. He sometimes quit work because of his nervousness and sometimes because he wanted to move on. His wanderlust was prominent prior to service. After mental examination, the examiner noted that the veteran had a poor school and industrial record, and at an early age developed a sense of antagonism toward authority and direction. Following a battle experience in North Africa, in which he was not wounded or injured, he developed nervousness, anxiety and a fright reaction that eventually caused his discharge. His anxiety and fright syndrome had not reoccurred since discharge and the veteran stated that he had improved so that he was now just the same as before the war. The diagnoses were psychoneurosis, anxiety state, recovered, and psychopathic personality, mixed type, with wanderlust, emotional instability, inadequate personality and tendency to falsification. The veteran was hospitalized in June 1945 for examination and observation to determine the nature and extent of the neuropsychiatric disease. At that time he reported that while leading a convoy on a motorcycle, the convoy was strafed, the motorcycle was hit and the veteran thrown aside and knocked unconscious. Since then he had been nervous. Additional history recorded noted that in a strafing incident the veteran jumped off his motorcycle while traveling about 35 miles an hour. He was not hit was received some minor injuries resulting from the fall, and claimed that he was unconscious for about 30 minutes. After he came to he walked to a bivouac area where he remained for several days, and was returned to duty; however he developed a marked state of nervousness consisting of headaches, tremulousness, insomnia, anxiety , startle reaction and marked fear of airplanes. At the present time he was considerable improved but he still had periodic attacks precipitated by prolonged and arduous work. The examination and observation impression was that the veteran was basically a psychopathic personality upon which a psychoneurosis had been engrafted. He definitely did have a sever anxiety in service and his “attacks” may be regarded as recurrent episodes in an already traumatized individual. The diagnoses were psychoneurosis, anxiety sate, in partial remission, and psychopathic personality, mixed type, with pathological emotionality and asocial trends. By rating action in August 1945, the 50 percent rating for the psychoneurosis was reduced to 30 percent. In file are 2 applications for vocation rehabilitation , one received in October 1944, and the other in June 1945. The October application shows a birth date in November 1920, completing 2 years of high school from 1933 to 1935. The June application shows a birth date in November 1923, completing 2 and 1/2 years of high school, from 1937 to 1940. His training was approved in February 1946, for Commercial Artist, Illustrating. A VA examination in August 1947 noted that the veteran had 11 months of service, 2 days of combat and was discharged with a diagnosis of psychoneurosis, anxiety. It was recorded that he had finished the 11th grade, and had been going to the Kansas City Art Institute for 2 years under Public Law #16. He was doing well in lithography, etching and painting, and was partners in a contracting business with his father. The veteran stated that he had no complaints, and reported that he used to have headaches but did not have them any more. The neuropsychiatrist reported that the veteran had no somatic complaints, and seemed to have made a very good social and economic adjustment to civilian life, and was about the same man that had entered service in “1943.” The diagnosis was no NP (neuropsychiatric) diagnosis. A rating action in September 1947 reduced the evaluation for the psychoneurosis to 0 percent. The veteran was hospitalized for a hemorrhoid problem in 1947, pilonidal cyst in 1948, acute appendicitis in 1950, a low back disability in 1953 while working as a ships carpenter, and minimal active pulmonary tuberculosis in 1959. In 1953 he reported being a college graduate, and on all associated applications for medical treatment he reported a birth year of 1920. In a December 1980 letter, H. Hauser, M.D., reported seeing the veteran in August 1980, for complaints of severe headaches since World War II, recurring every 2 to 3 months. In relating his past history, the veteran reported among other things that he was reduced to a zero percent evaluation by VA after getting into a fracas with an examining officer, that he had 2 years of college, and that he had skipped two grades in school. The examiner noted that it appeared the veteran suffered with psychophysiologic headaches probably on a post-traumatic psychoneurotic basis since 1945, and appeared to be in a mild mid life crisis type of depression from which recovery would be spontaneous. VA examination was conducted in April 1981. It was noted that the veteran had 3 hernia operations, 1 gallbladder surgery, could not lift or climb a ladder, and he had a 40 percent hearing loss. He was working part time as an electrician. The impression was minimal amount of anxiety. By rating action in April 1981 a 10 percent evaluation was assigned from May 1980. In hearing testimony in July 1982, in regard to a claim for service connection for hearing loss and tinnitus, the veteran reported that his convoy was struck by a German bomb, he was thrown out of the jeep he was riding in, and he was rendered unconscious for 4 to 5 hours, Transcript (T) pp. 3, 5 and 6 VA psychiatric examination was conducted in December 1982. The veteran reported that he served as a scout with a headquarters company , was fired upon on one occasion, and a projectile of some type exploded near him. He stated that during the first seven or eight years after service his sleep was restless, and he had bad dreams about air raids or bombing. He noted that physical impairment was the main reason for the reduction in his ability to work. He had been laid off four months earlier, but his employer thought highly of him and still employed him on a part time basis as a night watchman. He subsisted on small jobs he performed on a part time basis. He complained of frequent headaches and depression. The examination impressions were atypical anxiety disorder (anxiety reaction), and adjustment disorder with depressed mood secondary to physical disability. H. Hauser, M.D., in a letter to the VA in December 1989, reported that the veteran was planning to “sue” the VA and wanted a follow-up report. The veteran was poorly groomed, complained of sleep problems, nightmares from World War II, headaches, and sinusitis complicating his headaches. He also reported surgery on his left knee which he said was due to an old injury from the war, and 3 weeks before had prostatic surgery. The veteran was working at the Texas Department of Correction as a deficiency surveyor, and had been passed over for promotion due to his age and being overqualified. The veteran believed strongly that the VA was responsible for him losing his education and went into detail about being called in for a pension evaluation and kept in the hospital for a month, at a time when he was supposed to be taking final examinations. As a consequence he did not complete his college education and believed that he had never achieved in life all that he might have done. It was recorded that the veteran was not eligible for the G.I. bill because he was a disabled veteran, but when he benefits were reduced to zero he was no longer eligible for educational benefits under the “DAV” program. As a consequence of his failure to get a college degree he had lost opportunities to teach and advance in his present job. He reported awakening in the middle of the night with his heart pumping real fast, with the thought “What the hell am I good for anymore?” He would think about blow out his brains and then get angry about the way VA had screwed him, and decide to fight. Family problems, including drug abuse and law problems related to his children were noted. Received in March 1990, were copies of records from Memorial Neurological Association, showing treatment for the veteran since 1980. Dr. Hauser, in a letter dated in April 1984, reported that the veteran complained of headaches, increasing in persistence but not occurring every day. He was teaching electrical skills at the Texas Department of Correction for 15 months, and was pursuing obtaining a teaching certificate by attending night school. Since January 1984 he had recurrence of nightmares consisting predominantly of flashback memories of World War II experiences. The nightmares had been present until about 1950, and he had not had them since. Most of the flashbacks reflected events in North Africa where he suffered a head injury form which he dated all of his headaches and hearing problems. The examination impressions were chronic psychophysological headaches; post-traumatic psychoneurotic reaction; and mild depression. Portions of a report concerning psychological evaluation and testing in July 1984 were also submitted, without the evaluation impressions. A July 1984 hospital record, with Dr. Hauser as the treating physician, showed diagnoses of chronic severe headaches, psychophysiologic in origin; post traumatic psychoneurotic reaction; and mild depression. VA psychiatric examination was conducted in April 1990. The veteran reported consulting Dr. Hauser because of headaches involving the left side of his head. He reported that the headaches had been with him since World War II. The veteran complained of difficulty in sleeping at night, being easily irritated, difficulty in concentrating because of persistent headache, and forgetfulness. He stated that when awake he was an “extremely calm person” and not disturbed by sudden noises. Mental status examination showed the veteran to be alert, cooperative, and with normal rate and amount of speech that was relevant. He was dysphoric, oriented to time, place and person, and could recall 3 items immediately and 2 of 3 at three minutes. He became physically upset when talking about the pain in his head. He knew the names of 3 of the last 4 presidents, and gave abstract interpretation of a proverb. The diagnostic impression, Axis I, was anxiety disorder, not otherwise specified, with features of post traumatic stress disorder. By rating action in August 1990 a 30 percent rating was assigned for anxiety, from September 14, 1989. In hearing testimony in January 1991, the veteran reported constant headaches and sleep disturbance with no knowledge of a dream after waking up in a sweat with his heart pounding, T pp. 2 and 3. He also reported sleeping separate from his wife for 4 years because his thrashing around at night disturbed her, T p 4. The veteran reported that with attacks of anxiety his headaches increased in severity and frequency, and that usually on weekends he was headache free, T pp. 6 and 12. He denied taking any medication from Dr. Hauser or the VA, and noted that he was losing his job because he was sleeping at work because he could not sleep at night, T pp. 6 and 7. The veteran recited his work history, indicating he had left two prior lines of successful employment due to physical disabilities, and current job duties, and the reduction in his income, T pp. 7, 8 and 9. He also stated that he was pulled out of school in 1947, after an altercation with a doctor, and that if he had gotten a degree he would have been a good teacher, T p 12. Psychiatric examination by the VA was performed in October 1991. The claims file was not available to the examiner. The veteran described his headaches, and sleep problems, and noted that since his retirement it was much easier for him to relax. He reported that his work had become too much of a hassle and he had to get out. On mental status evaluation the veteran was alert and cooperative. He was tense and commented that a headache developed at the beginning of the interview. His affect was anxious and moderately dysphoric. His affect was appropriate to expressed thought content, his speech was normal in rate and amount, and the content was relevant and goal-directed. He was oriented time in 3 spheres. The Axis I diagnosis was anxiety disorder, not otherwise specified, with features of post-traumatic stress disorder, chronic, moderately severe. The examiner noted that the headaches appeared to be 2 types, one due to tension, and the other migraine in nature. Neurological evaluation was performed in November 1991. It was recorded that the veteran had headaches brought on by stress since 1943, and a second type of headache beginning in the late 1950’s early 1960’s. It was noted that there was no history of head trauma or other serious injury. The examination diagnoses were muscle contraction or tension headaches, and vascular type headaches. VA outpatient clinic records for 1991 and 1992, show that the veteran participated in a World War II PTSD group, and was treated for anxiety and hypertension. August 7, 1991, it was recorded that the veteran had a long history of anxiety and depression, and consultation was requested. When seen in late August 1991, the veteran related a history of combat in World War II, experiencing trauma and wounds from multiple air raids. He was very bitter toward the VA, and had a great deal of anger surrounding his military experience. The impression was PTSD. In hearing testimony in April 1992, the veteran reported being in Africa in late December 1942 or early January 1943, being under attacks or raids every day, and he retold the motorcycle messenger and convoy story, T pp. 2, 3 and 4. The veteran recounted his sleep problems, social isolation, job history, and the diagnosis of PTSD by Dr. Hauser, T pp. 8, 9, 10, and 11. The veteran’s spouse also provided testimony concerning the veteran’s sleep problems, and job changes, T pp. 12 and 13. A rating action in June 1992 awarded a 50 percent evaluation for anxiety with tension headaches, from August 7, 1991. VA outpatient clinic records for 1992, 1993, 1994, and 1995, show that the veteran participated in a monthly group, and was treated for some physical problems. In November 1992 it as noted that his son died at Holloween, and in September 1993 a friend died on a fishing trip. An October 1993 treatment plan review noted that the veteran had made good community adjustment and received no medications from the VA. He remained somewhat isolated socially, and was encouraged to participate more and was doing so. He was involved in ambulatory care for physical health maintenance and treatment. His social problems included adjustment to a chronic illness, affective disorder and community adjustment. an undated record, evidently part of a PTSD evaluation for the veteran set forth the 3 factors influencing the severity of PTSD. In August 1994 the veteran the veteran underwent psychological evaluation for PTSD. The examiner noted seeing the veteran on numerous occasions and it was his supposition that the veteran manifested moderate chronic symptoms of PTSD. It was recorded that the veteran entered the Army at age 17, was a scout patrol messenger, was pinned down by enemy fire numerous times while delivering messages, and, according to the veteran, spent 5 months serving in active combat duties, and suffering continuous bombing raids after the ground campaign was over. He reported being in a convoy taking prisoners to the coast when enemy planes attacked the convoy, and he was thrown out of the vehicle, and knocked unconscious for an extended period of time. When asked about the worst thing about the war, the veteran reported “witnessing of other Americans being killed for the diamonds they acquired while they were in Africa.” It was summarized that the met the criteria for a diagnosis of PTSD and that his impairment had chronically impacted his ability to function in society and interpersonally. When examined by the VA in December 1994, the veteran was in a wheelchair due to a recent cardiac catheterization. He reported his sleep problems, with bad dreams every night, some war related and some he could not recall. He also reported difficulty in controlling his temper, and taking only Hydroxyzine to sleep, with no other medication as treatment for his psychiatric problems. He had been a volunteer driver for DAV but quite after an argument. He had joined a local lodge about a year ago, and made more friends than previously, and found his activities satisfying. The veteran complained of a headaches since September, with an MRI only showing minimal sinus disease. On mental status examination the veteran was tense, but alert and cooperative. His mood was dysphoric and disgruntled. His affect was angry but controlled and appropriate to expressed thought content. His speech was normal in rate and amount, and the content was relevant and goal-directed. He was oriented to time, place and person, registered 3 items immediately, and recalled all three items at three minutes. He was able to recall the names of the four most recent presidents, and made no errors in calculations. The Axis I diagnoses were post-traumatic stress disorder, chronic, and psychologic factors affecting physical condition (headaches). The global assessment of functioning (GAF) was 51, noting few friends, and conflicts with associates. Psychiatric examination was again performed in October 1995. The veteran reported bad dreams almost every night, sometime dreaming specifically of fire which he related to the occasion when he was knocked unconscious during an air raid, and returned to consciousness with his surroundings on fire. He was taking alprazolam for sleep, admitted to being short tempered, and stated that the group therapy helped him to control his behavior. He was managing the affairs of his sister-in-law, and taking care of her property. The mental status findings, and diagnoses were essentially the same as in December 1994, with the assignment of a 50 for GAF. Also in file are records of private treatment for the veteran in 1995 and 1996. When the veteran moved from Lufkin to Bay City, he was provided with a psychiatric examination, in May 1996, which noted that the veteran was coping with his psychiatric symptoms and taking care of his wife who was deteriorating physically. He was taking Xanax and it was noted that when referred to World War II group he went to a combat group in error, did not feel comfortable, and stopped coming. There were no significant changes in the mental status examination, and the diagnosis was PTSD, remote history of alcohol abuse. On physical examination in July 1996, the veteran reported discharge from service due to a mental problem and left foot injury. He also reported receiving second degree burns in May 1943. Neurological evaluation was also performed in July 1996, in regard to the veteran’s headaches. The impressions were migraine headaches without aura, and history of post- traumatic stress disorder and associated tension headaches. Psychiatric examination in July 1996 noted discussion of the veteran’s psychiatric clinical state in relationship to his headaches. The veteran was alert, cooperative, and his mood was moderately dysphoric, with underlying irritability. His affect was moderately constricted in range but was appropriate to expressed thought content. His speech was normal in rate and amount, and the content was relevant and goal directed. No cognitive defects were noted. The Axis I diagnoses were PTSD, and psychological factors effecting physical condition. The GAF was 50. There was a discussion of changes in GAF scores, noting that a change from 51 to 50 specified a small change in the mid-zone of the continuum between 41 and 60. C. Sermas, M.D., in a statement dated in October 1996, reported that the veteran was 70 years old, married 48 years and retired since 1992. It was reported that the veteran was thrown out of his jeep by a bomb blast, lost consciousness, and suffered second degree burns from sun exposure. He was found by friendly troops and taken to a hospital in Oran. Since then he had experienced a variety of symptoms, such as nightmares, extreme irritability, anhedonia, depression/despondency, suicidal ideation, panic attacks, flashbacks and reduced sleep. It was noted that the veteran’s symptoms has persisted over the years, and Dr. Semas believed that the veteran was suffering from PTSD related to his war experience. The veteran was started on Remeron and Depakote and to be followed up as an outpatient. J. Bergland, M.D., in a statement dated in February 1997, reported that the veteran had been a patient since September 1995, and had a long history of severe anxiety, reaching a level of seven on a scale of one to ten. He was presently on Alprazolam for the anxiety. The doctor stated that the veteran was quite disabled from his anxiety and had been unable to be gainfully employed mostly because of his medical disability. The veteran completed VA Form 221-8940 in July 1997 and reported that he was born in November 1925, last worked in May 1992, and completed 3 years of college, with no other education or training. ANALYSIS An Evaluation in Excess of 30 Percent Prior to August 7, 1991 Prior to addressing the application of the facts to the rating criteria, the Board is compelled by the record to first comment on the question of credibility. Under the law, the Board is obligated to account for and asses the credibility of the veteran’s sworn testimony. Hatlestad v. Derwinski, 3 Vet. App. 213 (1992). The Board finds clear and probative contemporaneous evidence recorded at the pertinent time period in service that the appellant had been exposed to bombing and strafing, but had experienced no direct combat with the enemy. The specific incident that occasioned his entry into the medical treatment chain, which ultimately resulted in his discharge from service, involved an incident when he was strafed while riding a motorcycle. (The Board further notes that not only is this documented in the original treatment records, the veteran gave this same history on VA evaluation in June 1945.) He was frightened, but there was no indication by complaints, history or findings of any physical injuries or unconsciousness. He was picked up by buddies and returned to his company. These hospitalization records also contain statements of medical history in the context of treatment that the appellant had experienced headaches “all his life.” Post service records show the appellant specifically denying nightmares or sleep disturbance in December 1943 and November 1944. It is notable that both the VA evaluation in April 1945 and August 1947 depict the appellant as having returned to his pre- service baseline of adjustment. In support of his current claim, the appellant has presented an account that his compensation award was reduced to zero in the 1940’s after he became involved in an altercation with a VA examiner. There is no support for this assertion whatsoever in the record. He has alleged that the incident leading to his hospitalization inservice involved an event when a German bomb exploded near the truck he was riding in. He has claimed a period of unconsciousness of hours duration. He has variously reported that after being bombed, he was surrounded by fire or that he experienced burns from sun exposure in service. He has reported disturbed sleep for the first seven or eight years after service, with disturbed dreams. All of this is contradicted by the far more probative contemporary records in service and on the initial VA evaluations. At the 1994 VA examination, he reported duty as a scout patrol messenger and being pinned down by enemy fire many times. This is unsupported by any credible evidence from the service department and contradicted by the history recorded for treatment purposes in service. He has alleged that he was called in for a VA examination post service and held for a month, thus preventing him from completing his education. This is contradicted by the far more probative contemporaneous records. The record further shows the appellant has been grossly inconsistent in even reporting his date of birth. With respect to the headaches disorder which has been separately rated, the Board notes that the medical evidence used to support that grant contained a material defect. The examiner’s opinion was not based on a review of the service medical records and the post-service VA treatment records, which document clearly the pre-service existence of a headache disorder, an episode of headaches in service, and the resolution of the headaches post-service followed by a protracted period of quiescence. Rather, the examiner apparently based his opinion on the erroneous history presented by the appellant that the headaches had their onset in service. As the above summary indicates, in the context of his current claim, the veteran has recited a history that is in many ways dramatically in conflict with what the record documents during and after service. It may well be that the appellant’s current history reflects his current faulty recollections of these events, however, the credible evidence of record shows those recollections are not accurate. The veteran is entitled to received compensation for disability due to disease or injury of service origins. He is not entitled to receive compensation based upon imagined disease or injury of service origin. The Board has considered whether the current claim should be returned to the RO for a further set of examinations to be based upon an accurate history. This action, however, would lead to questions concerning the validity of the grant of service connection for a headache disorder, and perhaps the accuracy of the diagnosis of PTSD in this case. The issue now before the Board, however, is that of a rating in excess of that currently assigned for the service connected disorder, not the propriety of the current award granted by the RO. The VA has provided the appellant with an examination. The fact that the examiner was accorded erroneous history by the appellant is not a defect on the part of VA. The duty to assist is not a one way street, and the Board finds the VA has discharged its duty to the extent the cooperation of the appellant has permitted. Wood v. Derwinski, 1 Vet. App. 190 (1991) (aff’d on reconsideration, 1 Vet. App. 460 (1991); Olson v. Principi, 3 Vet. App. 480, 483 (1992). Accordingly, since the return of this case for further development will not shed light on whether a higher evaluation is warranted, the Board finds that the current record is adequate for resolving the issue now in appellate status. Turning to the merits of the specific claims on appeal, the veteran reopened his claim for an increased rating for his service-connected psychiatric disorder in September 1989, and the first question before the Board is whether an evaluation in excess of 30 percent is warranted prior to the award of a 50 percent rating effective August 7, 1991. The answer to this question is no. The December 1989 letter from Dr. Hauser only shows that the veteran blamed the VA for his various problems, and was experiencing situation difficulties with his job, family and own medical health. As noted above, the appellant’s accounts of actions by VA are not credible. There was no specific psychiatric evaluation or diagnosis, and the letter provides no basis upon which to find that the veteran had considerable industrial impairment. In passing the Board points out that the private medical records submitted in March 1990 were related to treatment in 1984, and while of some historical value, the veteran did not reopen his claim until 1989, so they are not pertinent to the question of his medical status proximate to the time of his reopened claim. Francisco, supra. The only medical record available after the above records, and before the VA outpatient clinic records starting in August 1991, is the VA examination in April 1990. That examination showed the veteran to be dysphoric, concerned about his headaches, and with sleep disturbance but otherwise he was alert, oriented, relevant, had decent recall, was goal oriented, and he could abstract. He was working at the same job he had since 1982. He was not taking any specific psychotropic medication. The RO evaluated these psychiatric manifestations as reflective of moderate disability, although the basis for that increased award is obscure. Clearly, there were no findings or even history that suggested more than moderate disability. The Board notes that in hearing testimony in January 1991, the veteran reported that with attacks of anxiety, his headaches increased in severity and frequency, and that usually on weekends he was headache free. He also denied taking any medication from Dr. Hauser or the VA. There was comment on his sleep problems, and his problems at work. The Board finds that the veteran again provided inaccurate history as to events in the late 1940’s, and this reflects on his credibility as a historian of the manifestations of his disorder. There is no evidence to substantiate his bare claim that he was losing his job because he could not sleep at night. On an over view, giving consideration to December 1989 statement by Dr. Hauser, the clinical findings on VA examination in April 1990, and the hearing testimony in January 1991, the Board finds that the psychiatric symptomatology manifested by the veteran prior to August 7, 1991 did not show more than moderate impairment under the regulations in effect at that time. The Board notes that the while the veteran is competent to relate his various symptoms, he is not shown to be medically qualified to render an opinion as to the severity of his disorder. Espiritu v. Derwinski, 2 Vet. App. 492 (1992). Given the above fundamental facts, the benefit of the doubt doctrine is not for application because the overwhelming weight of the evidence is against the claim. In this context, the Board further notes that while the regulatory criteria changed after the claim for increase was filed and during this appeal, the law and regulations governing the effective date of awards would preclude the application of the 1996 changes retroactively. 38 U.S.C.A. § 5011(g) (West 1991 & Supp. 1997); 38 C.F.R. §§ 3.114; 3.400 (1997); DeSousa, supra. An Evaluation in Excess of 50 Percent The VA psychiatric examination in October 1991, and the VA clinic records beginning in August 1991 are apparently the basis for the 50 percent evaluation assigned by the RO for the veteran’s service-connected psychiatric disorder. He was receiving out-patient treatment. Clinically the veteran was anxious and moderately dysphoric, and the remainder of the findings were essentially the same as in April 1990. He was taking medication to sleep, but no other medication for his psychiatric disorder. The veteran had retired from work, and in October and November 1991 there was a finding that he had 2 separate types of headaches. The Board notes that he is service-connected for tension headaches, but not vascular headaches. In summary, the changes apparently responsible for the RO’s decision to increase the award to 50 percent were the veteran’s group therapy treatment, and reported combat with anxiety believed to be related to PTSD. At this point, in regard to the PTSD, it is for consideration that there is no dispute that the veteran was involved in a strafing incident in May 1943, and that afterwards he developed a psychoneurosis not previously exhibited. That alone may well be sufficient for a diagnosis of PTSD; however, the veteran complicates the evaluation of that disorder when he recounts events that are not supportable by the facts in this case and, indeed, are flatly contradicted by the earlier versions of events provided by the appellant and recorded in the service medical records. This point is relevant to the medical text the appellant submitted in support of his application for the proposition that three factors influencing how severe PTSD will be: (1) The severity of the trauma; (2) the age at which the trauma occurred (the younger the more severe); and (3) the degree of support that the victim receives from others during and after the trauma. On VA psychological evaluation in August 1994, the veteran reported being 17 years old when he entered the Army, that he spent 5 months in active combat, and that he was knocked unconscious for an extended period of time. At other times he has reported wandering around on his own after the strafing incident. A diagnosis of PTSD was made after the August 1994 evaluation. The record shows that his accounts of his age at the time of the incidents and the severity of trauma are both contradicted by more probative evidence. The veteran reported on enlistment in 1942 that he was born in November 1923; on his original VA claim in October 1943 he reported a birth year of 1920, and this is the year that he used in subsequent applications for health care. This also appears to be the date he uses when receiving private treatment. In a VA form in July 1997 he reported a birth year of 1925. As discussed above, the contemporaneous documents indicate that the strafing was his first direct combat involvement. After the strafing the veteran was helped by his buddies, and hospitalized in very short order. There is no support for his account of unconsciousness. Thus, the Board finds that the text submitted by the appellant, when considered in light of the credible evidence of record, provides no support for an increased rating. The next psychiatric examination for the veteran were performed in December 1994, and October 1995. These two examinations are essentially the same, and show dysphoria and constricted affect but speech was normal, content relevant and goal directed. The veteran was alert, oriented, and his recall was better than in 1990. He was still having sleep problems, and bad dreams. Social isolation was reported but he was able to function in society, and was managing the affairs of his sister-in-law who was in a nursing home. The above examinations are noteworthy for the GAF scores of 51 and 50, respectively. A GAF of 50 (actually the range of scores from 41 to 50) is for “[s]erious symptoms (e.g. suicidal ideation, server obsessional rituals, frequent shoplifting) OR any serious impairment in social, occupational, or school functioning (e.g. no friends, unable to keep a job).” Diagnostic and Statistical Manual of Mental Disorders 32 (4th ed. 1994), cited in Richard v. Brown, 9 Vet. App. 266 (1996). A GAF score of 55 to 60 (actually 51 to 60) is for “moderate difficulty in social, occupational, or school functioning.” Diagnostic and Statistical Manual for Mental Disorders, 32 4th ed. (1994), as cited in Carpenter v. Brown, 8 Vet. App. 240, 242 (1995). The Board notes that the private out-patient treatment records for the veteran for 1995 and 1996, essentially address his medical problems. The VA examination in May 1996 was brought about when the veteran moved, and on that occasion he was euthymic, and there were no negative findings. Psychiatric examination in July 1996 included a discussion of the veteran’s headaches. He was moderately dysphoric with underlying irritability. His speech was normal, and no cognitive defects were identified. Essentially, there was no real change in the veteran’s symptoms from the earlier examinations in 1991, 1994 and 1995. Dr. Sermas, in October 1996, recounted war experiences as related by the veteran and psychiatric symptoms he considered consistent with a diagnosis of PTSD. The physician did not have the advantage of review of all of the veteran’s medical records, and particularly did not address the effect of the various symptoms on the veteran’s ability to function socially and occupationally. He merely diagnosed PTSD. Dr. Bergland, in February 1997, stated that the veteran’s severe anxiety was 7 on a scale of 1 to 10. However, he also found that the veteran was unable to work due to his multiple medical problems. Dr. Bergland did not explain the significance of 7 on a scale of 10 in terms of effect on socializing and working. He made no references to deficiency in judgment, thinking, mood, or other manifestations associated with a psychiatric rating higher than 50 percent. The above examinations do not reflect disability rated 70 percent under the new criteria. The veteran was not found to be obsessional, with illogical speech, near continuous panic or depression affecting his ability to function independently, disoriented, unable to control his impulses, or neglectful of his appearance. The record also does not show that he was unable to establish or maintain relationships. Recent records revels that the veteran has joined a lodge and enjoys his grand children. The record also shows that the veteran enjoys fishing and fishes with others. With reference to the GAF scores, they would appear on their face to be more closely analogous to the old rating criteria. Under the old criteria, a seventy percent evaluation requires severe industrial and social impairment. A GAF score of 50 is falls in the range for “serious” impairment, while a score of 51 falls in the range for “moderate” impairment. However, as cogently pointed out by the RO, the 50 score is not necessarily supported by the clinical findings, and the examiner in July 1996 pointed out that 50 was mid-point on a continuum from 41 to 60, reflecting behavior described in the parentheses for both segments of the scale. The physician further noted that the 50 score represented a “small clinical change, and not the large and sudden change that is seen if one simply contrasts the contents of the two sets of parentheses.” In Carpenter, the Court affirmed a decision of the Board denying a rating in excess of 50 percent where the GAF score was in the 51 to 60 range. 8 Vet. App. at 243-44. Thus, given the actual clinical findings, the explanation by the physician of the significance of the GAF scores, and the prior interpretation of the significance of even the higher GAF score, the Board finds that the record clearly does not support the assignment of a rating beyond 50 percent for the service connected disability. Since the most probative evidence preponderates against the claim, the benefit of the doubt doctrine is not for application. ORDER An evaluation in excess of 30 percent prior to August 7, 1991 is denied. An evaluation in excess of 50 percent is denied. RICHARD B. FRANK Member, Board of Veterans' Appeals NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991 & Supp. 1997), a decision of the Board of Veterans' Appeals granting less than the complete benefit, or benefits, sought on appeal is appealable to the United States Court of Veterans Appeals within 120 days from the date of mailing of notice of the decision, provided that a Notice of Disagreement concerning an issue which was before the Board was filed with the agency of original jurisdiction on or after November 18, 1988. Veterans' Judicial Review Act, Pub. L. No. 100-687, § 402, 102 Stat. 4105, 4122 (1988). The date which appears on the face of this decision constitutes the date of mailing and the copy of this decision which you have received is your notice of the action taken on your appeal by the Board of Veterans' Appeals. - 2 -