Citation Nr: 0006255 Decision Date: 03/08/00 Archive Date: 03/17/00 DOCKET NO. 91-48 016 ) DATE ) ) On appeal from the Department of Veterans Affairs (VA) Regional Office in Montgomery, Alabama THE ISSUES 1. Entitlement to an evaluation in excess of 50 percent for a variously diagnosed psychiatric disability, including paranoid schizophrenia with post-traumatic stress disorder, for the period prior to July 10, 1998. 2. Entitlement to an effective date earlier than July 10, 1998 for an evaluation in excess of 70 percent for service- connected psychiatric disability. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD R.P. Harris, Counsel INTRODUCTION The appellant had active service from June 1966 to May 1969. This matter originally came before the Board of Veterans' Appeals (Board) on appeal from an October 1989 rating decision by the Montgomery, Alabama, Regional Office (RO), which denied entitlement to an increased (compensable) rating for the service-connected psychiatric disability. By a rating decision in December 1990, service connection was denied for diabetes mellitus. In a decision rendered on April 14, 1992, the Board denied service connection for diabetes mellitus on the basis that the claim was not well grounded and denied a compensable evaluation for the service- connected psychiatric disability. Thereafter, the appellant appealed the Board's decision to the United States Court of Appeals for Veterans Claims (formerly known as the United States Court of Veterans Appeals) (Court). By Order rendered January 19, 1993, the Court vacated the Board's April 14, 1992, decision, and remanded the case to the Board for certain additional development. Subsequently, in September 1993 and August 1994, the Board remanded the case to the RO for additional development as directed. In the August 1994 remand, the Board pointed out that in its prior September 1993 remand, the appellant's statements had been determined to have, in part, raised the issue of whether a September 1989 Board decision, which denied a compensable evaluation for the service-connected psychiatric disability, was clearly and unmistakably erroneous; and that these statements were construed as a request for reconsideration of that Board decision. In a written statement dated in October 1995, appellant expressly withdrew this request for reconsideration of that decision. In a December 1995 decision, the Board denied entitlement to service connection for diabetes mellitus and a low back disability; denied entitlement to a temporary total disability rating based upon hospitalization from January to March 1993; dismissed for lack of legal merit appellant's claim that unappealed rating decisions of August 1969, November 1971, and October 1972, insofar as the service- connected psychiatric disability is concerned, were clearly and unmistakably erroneous; granted restoration of a 50 percent rating for appellant's psychiatric disability on the grounds that an unappealed rating decision of March 1979 (confirmed by an August 1979 rating determination) was clearly and unmistakably erroneous; granted service connection for post-traumatic stress disorder; and denied a current evaluation in excess of 50 percent for appellant's variously diagnosed psychiatric disability. A January 1996 implementing rating decision increased the rating for the service-connected psychiatric disability from 30 percent to 50 percent, effective June 1, 1979. In March 1996, appellant filed with the Board a motion for reconsideration of the Board's December 1995 decision. In September 1996, the Deputy Vice Chairman, by direction of the Chairman, under the authority granted in 38 U.S.C.A. § 7103 (West 1991), denied that motion. Additionally, appellant appealed to the Court that part of the December 1995 Board decision which had denied service connection for diabetes mellitus and a low back disability; denied a temporary total disability rating based upon hospitalization from January to March 1993; dismissed for lack of legal merit appellant's claim that unappealed rating decisions of August 1969, November 1971, and October 1972, insofar as the service- connected psychiatric disability is concerned, were clearly and unmistakably erroneous; and denied a current evaluation in excess of 50 percent for appellant's variously diagnosed psychiatric disability. The VA amended its regulations for rating mental disorders, effective November 7, 1996. See 38 C.F.R. §§ 4.125-130 (1997-99). Section 4.132 has been redesignated as § 4.130. In a May 1997 memorandum decision, the Court affirmed that part of the Board's December 1995 Board decision which had denied service connection for diabetes mellitus and a low back disability; denied a temporary total disability rating based upon hospitalization from January to March 1993; and dismissed for lack of legal merit appellant's claim that unappealed rating decisions of August 1969, November 1971, and October 1972, insofar as the service-connected psychiatric disability is concerned, were clearly and unmistakably erroneous. However, in that May 1997 memorandum decision, the Court vacated and remanded that part of the Board's decision which had denied a current evaluation in excess of 50 percent for appellant's variously diagnosed psychiatric disability, for adjudication under the newly revised VA regulations pertaining to rating mental disorders. In February 1998, the Board remanded to the RO the issue of entitlement to a current evaluation in excess of 50 percent for appellant's variously diagnosed psychiatric disability for additional development as directed. In a September 1998 rating decision, the RO increased the evaluation for the variously diagnosed psychiatric disability, including paranoid schizophrenia with post-traumatic stress disorder, from 50 percent to 70 percent, effective July 10, 1998. Appellant subsequently appealed the issue of entitlement to an earlier effective date for said disability. In a February 1999 rating decision, the RO granted a total rating based on individual unemployability, effective July 10, 1998. In a written statement dated later that month, in response to notice of that February 1999 rating decision, appellant stated, in pertinent part, that "I am satisfied with the rating of 80 percent service connected with individual unemployability...." The Board construes this as a written withdrawal of the appellate issue of an increased rating for the service-connected psychiatric disability, for the period on and subsequent to July 10, 1998. See 38 C.F.R. § 20.204(b)(c) (1999). Consequently, the Board has reframed the appellate issues as entitlement to an evaluation in excess of 50 percent for a variously diagnosed psychiatric disability, including paranoid schizophrenia with post- traumatic stress disorder, for the period prior to July 10, 1998; and entitlement to an effective date earlier than July 10, 1998 for an evaluation in excess of 70 percent for service-connected psychiatric disability. In view of the foregoing, this decision is limited to the issues set forth on the title page. FINDINGS OF FACT 1. All available, relevant evidence necessary for disposition of the appeal, to the extent legally required, has been obtained by the RO. 2. A September 1989 Board decision affirmed a noncompensable rating for appellant's service-connected psychiatric disability. 3. Appellant reopened his claim for a compensable rating for the service-connected psychiatric disability on October 3, 1989. 4. In a December 1995 decision, the Board granted restoration of a 50 percent rating for appellant's psychiatric disability on the grounds that an unappealed rating decision of March 1979 (confirmed by an August 1979 rating determination) was clearly and unmistakably erroneous; and granted service connection for post-traumatic stress disorder. A January 1996 implementing rating decision increased the rating for the service-connected psychiatric disability from 30 percent to 50 percent, effective June 1, 1979. 5. In a September 1998 rating decision, the RO granted an increased rating for appellant's variously diagnosed psychiatric disability, including paranoid schizophrenia with post-traumatic stress disorder, from 50 percent to 70 percent, effective July 10, 1998. 6. Appellant's service-connected psychiatric disability, for the period prior to July 10, 1998, was manifested primarily by complaints of anxiety, depression, memory and sleep difficulties, irritability, recurrent intrusive thoughts and occasional nightmares and flashbacks relating to wartime experiences. During the period in question, his psychiatric disability resulted in no more than moderate social and industrial inadaptability. During the period in question, his psychiatric disability was not manifested by suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately, and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); and inability to establish and maintain effective relationships. 7. It was not factually ascertainable prior to July 10, 1998 that appellant's service-connected psychiatric disability more nearly resulted in at least severe social and industrial inadaptability. 8. It was not factually ascertainable that appellant's service-connected psychiatric disability more nearly resulted in social and industrial inadaptability with deficiencies in most areas, for the period between November 7, 1996 and July 10, 1998. CONCLUSIONS OF LAW 1. The criteria for an evaluation in excess of 50 percent for appellant's service-connected psychiatric disability, for the period prior to July 10, 1998, have not been met. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. § 3.321(b)(1), 4.1, 4.2, 4.7, 4.10, 4.129, 4.130, 4.132, Diagnostic Codes 9203, 9400, 9411 (1989-1999). 2. The criteria for an effective date earlier than July 10, 1998 for an evaluation in excess of 70 percent for appellant's service-connected psychiatric disability have not been met. 38 U.S.C.A. §§ 1155, 5110(b)(2) (West 1991); 38 C.F.R. § 3.400(o)(2) (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Initially, the Board finds that the appellant's claims on appeal are "well grounded" within the meaning of 38 U.S.C.A. § 5107(a) (West 1991), in that the claims are plausible. After reviewing the record, the Board is satisfied that all relevant facts have been properly developed with respect to the issues on appeal and that no useful purpose would be served by again remanding the case with directions to provide further assistance to the appellant. Pursuant to the Board's September 1993 and August 1994 remands, additional, pertinent VA medical records were sought by the RO, and any such records, to the extent of their availability, were obtained. Moreover, VA psychiatric examinations and social and industrial surveys were conducted in 1993 and 1995, which are sufficiently detailed and comprehensive regarding the severity of his psychiatric disability. Pursuant to the Board's February 1998 remand, additional VA and private medical records and Social Security Administration (SSA) records were obtained and a July 10, 1998 VA psychiatric examination was conducted. Since the relevant period with respect to the Board's deciding the appellate issues in this case involves the period prior to July 10, 1998, any medical records dated after that date are immaterial. It should be added that the psychiatric disability increased rating issue on appeal has been in appellate status for more than a decade. There is no indication in the record that there are additional records that would have a bearing on the outcome as to that appellate issue or the earlier effective date appellate issue. Therefore, based on the assembled medical evidence of record, the Board will provide adequate reasons and bases for its decision of the issues on appeal, and will apply applicable laws and regulations to the material facts. Thus, the Board concludes that the duty to assist the appellant, to the extent legally required, in the development of facts pertinent to his claims, as contemplated by the provisions of 38 U.S.C.A. § 5107(a), has been satisfied. I. An Evaluation in Excess of 50 Percent for a Variously Diagnosed Psychiatric Disability, Including Paranoid Schizophrenia with Post-Traumatic Stress Disorder, for the Period Prior to July 10, 1998 Appellant contends, in essence, that his psychiatric symptomatology was of such severity as to warrant an evaluation in excess of 50 percent for the period prior to July 10, 1998. It is requested that applicable statutory and regulatory provisions be considered, including 38 C.F.R. § 4.7, pertaining to the higher of two evaluations, and that the benefit-of-the-doubt doctrine be applied. The RO granted service connection for schizophrenia (a psychosis) and an anxiety neurosis (a psychoneurosis) in its August 1969 and November 1971 rating decisions, respectively, and the Board in a December 1995 decision, granted service connection for a post-traumatic stress disorder (a psychoneurosis also). Since his service-connected psychiatric disability is variously diagnosed, the Board will consider all psychiatric symptoms regardless of etiology, in rating the severity of his psychiatric disability for the pertinent period prior to July 10, 1998. Disability evaluations are determined by application of a schedule of ratings which is based on average impairment of earning capacity under the VA's Schedule for Rating Disabilities. 38 U.S.C.A. § 1155; 38 C.F.R. Part 4. The Board will consider the appellant's service-connected psychiatric disability in the context of the total history of that disability, particularly as it affects the ordinary conditions of daily life, including employment, as required by the provisions of 38 C.F.R. §§ 4.1, 4.2, 4.10 and other applicable provisions. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). However, as the Court stated in Francisco v. Brown, 7 Vet. App. 55, 58 (1994), "[w]here...an increase in the disability rating is at issue, the present level of disability is of primary concern." The service medical records revealed that appellant had paranoia of near delusional intensity, which had been diagnosed as a character behavior disorder (paranoid personality). Shortly after service, he reportedly became confused, restless, and suspicious and was admitted for VA hospitalization in May 1969. During hospitalization, he experienced suspiciousness, but with psychotropic medication, adjusted well, and intended to attend school at discharge. Schizophrenia, chronic undifferentiated type, was diagnosed. The RO granted service connection and assigned a 10 percent rating under Diagnostic Code 9204. By a November 1971 rating decision, the 10 percent evaluation for the service-connected schizophrenia was confirmed, but that disability was reclassified as an anxiety neurosis and rated under Diagnostic Code 9400. A report of VA hospitalization from April to May 1971 reflects that appellant was admitted for various physical complaints, including dizziness; and that it was noted medically that his problem was mostly anxiety. He expressed a desire to be discharged in order to enroll in college; and he was medically cleared to return to work immediately. The sole diagnosis was anxiety neurosis. The RO confirmed the 10 percent rating for the service-connected psychiatric disability, which was reclassified as an anxiety neurosis and rated under Diagnostic Code 9400 (following termination of a temporary total hospitalization rating). By an October 1972 rating decision, the 10 percent evaluation for the service-connected psychiatric disability was increased to 50 percent, effective February 22, 1972, and that disability was reclassified as schizophrenia, paranoid type. A report of a September 1972 VA neuropsychiatric examination revealed that appellant had various complaints, including anxiety, depression, and feelings that people were persecuting him. Clinically, he was oriented, his behavior was normal, and his speech relevant and coherent. However, he admitted to auditory hallucinations, and ideas of reference and persecution. His memory and insight were impaired, affect was shallow, and judgment fair. The sole diagnosis was schizophrenia, paranoid type, and incapacity was considered marked. However, since that VA neuropsychiatric examination indicated the appellant was oriented, in good contact with reality, and with normal behavior, his "admitting" to hallucinations and associated psychotic symptoms was apparently by history only. On February 1979 VA psychiatric examination, appellant stated to the examiner that he had no type of psychiatric disability, and instead referred to a physical problem. He denied engaging in any regular activities. The mental status evaluation noted that he was well oriented, without psychotic or cognitive impairment. The impression was that no mental illness was presently indicated. On VA psychiatric examination in February 1981, appellant reported that he was employed with a veterans service organization as an employment interviewer since October 1980. It was indicated that he had cognitive difficulties and was suspicious and guarded. Later in 1981, he reportedly was a full-time college student in a personnel management program; and was in a work-study program for a State employment service. A VA neuropsychiatric examination report in December 1984 reflects that he was on sick leave due to a rectal disability. He had completed three years of college. He was well-oriented, had appropriate behavior, and socialized well. However, he reportedly experienced anxiety and paranoid ideation. Paranoid schizophrenia was diagnosed, which was considered to result in minimal social and moderate to severe industrial inadaptability. During an April 1988 VA neuropsychiatric examination, appellant appeared oriented, without anxiety, depression, or psychotic ideation. He was a veterans service organization employee. The assessment was paranoid traits, no psychosis shown; and he was considered to have minimal social and no industrial impairment. A May 1988 rating decision reduced the evaluation for the service-connected psychiatric disability from 30 percent to noncompensable, effective September 1, 1988. A September 1989 Board decision affirmed a noncompensable rating for appellant's service-connected psychiatric disability. In pertinent part, the VA's Schedule for Rating Disabilities, effective on and subsequent to February 3, 1988 and prior to November 7, 1996 amendment, provided a general rating formula for psychotic disorders, including schizophrenia (Diagnostic Codes 9201-9205), and psychoneurotic disorders, including anxiety neurosis/generalized anxiety disorder (Diagnostic Code 9400) and post-traumatic stress disorder (Diagnostic Code 9411), based upon the degree of incapacity or impairment: "Considerable" social and industrial impairment warranted a 50 percent evaluation; and "severe" warranted a 70 percent evaluation. For psychoses, a 100 percent evaluation required active psychotic manifestations of such extent, severity, depth, persistence or bizarreness as to produce total social and industrial inadaptability. For psychoneuroses, a 100 percent evaluation required that attitudes of all contacts except the most intimate be so adversely affected as to result in virtual isolation in the community and there be totally incapacitating psychoneurotic symptoms bordering on gross repudiation of reality with disturbed thought or behavioral processes (such as fantasy, confusion, panic, and explosions of aggressive energy) associated with almost all daily activities resulting in a profound retreat from mature behavior; and the veteran is demonstrably unable to obtain or retain employment. 38 C.F.R. § 4.132. In Hood v. Brown, 4 Vet. App. 301, 303 (1993), the Court stated that the term "considerable" was declared as meaning "rather large in extent or degree." The amended VA's Schedule for Rating Disabilities (effective November 7, 1996) provides a general rating formula for mental disorders, including schizophrenia, post-traumatic stress disorder, and anxiety disorder: A 100 percent evaluation requires 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 the 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. A 70 percent rating requires occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately, and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); inability to establish and maintain effective relationships. A 50 percent rating requires occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships. 38 C.F.R. § 4.130 (effective November 7, 1996). VA clinical records indicated that in May 1993, appellant reportedly was unable to work due to a back disability. He was depressed; and it was noted that the depression was attributed in part to a physical problem. Significantly, in his 1993 application for SSA benefits, appellant reported that he had been employed as a veterans service organization counselor/hospital service coordinator five days a week from February 1988 to January 26, 1993; that he had been totally disabled and unemployable since January 1993 due to physical and psychiatric disabilities; that he had constant low back pain and other physical disabilities; that he was unable to sit/stand for a prolonged period of time; that he required a cane and wheel chair; and that his psychiatric symptoms included anxiety and depression. In an August 1993 SSA notice of denial of disability benefits, it was indicated that appellant alleged an inability to work due to chronic low back pain, diabetes mellitus, cardiac ischemia, history of schizophrenia, and post-traumatic stress disorder. However, it was held that he was employable in positions that did not require heavy lifting and required a short, on-the-job training period. A November 1993 VA psychiatric examination report reflects that appellant was in a wheelchair due to back problems. He complained of post-traumatic stress disorder symptomatology, including nightmares 3 to 4 times a week. Clinically, he appeared correctly oriented, and his memory and other cognitive functions were intact. He exhibited no paranoid ideation in his life, except with respect to the VA. He reportedly was frustrated with the VA over his attempts to change his diagnosis from schizophrenia to post-traumatic stress disorder. There were no hallucinations or delusions, although reference was made to his having at least one nightmare per week related to his overseas experiences. It was indicated that his socialization was limited due to fear of crowds; and that he had occasional intrusive thoughts. The examiner stated that appellant had been unable to work for approximately the past year due to his back disability. The diagnosis was post-traumatic stress disorder, considered to result in moderate social and industrial inadaptability. A Global Assessment of Functioning (GAF) Scale score was assigned of 50 (currently), and 55 (for the past year). A December 1993 VA social and industrial survey reflected similar findings as those reported on that November 1993 examination. A December 1993 statement from a VA psychiatrist (who had conducted said November 1993 VA psychiatric examination) reported that appellant was currently receiving treatment for post-traumatic stress disorder and several physical disabilities (including diabetes, hypertension, angina- myocardial infarction, and ruptured disks of the low back). He concluded that appellant was "somewhat limited in his activities; however he has been continuously disabled and unemployable since January 1993." An August 1994 VA clinical record stated that appellant "has serious back problems as well as a service[-]connected nervous condition which have rendered him disabled and unable to work at this time." However, in evaluating the severity of the service- connected psychiatric disability, disabilities for which service connection is not in effect may not be considered. Said December 1993 statement and August 1994 VA clinical record clearly indicate that the medical conclusions as to unemployability were based at least in part on disabilities for which service connection is not in effect, not solely on the service-connected psychiatric disability. In a September 1994 SSA Administrative Law Judge's decision, based in part upon that December 1993 statement from a VA psychiatrist, the judge determined that "[t]he claimant's impairments which are considered to be [']severe['] under the Social Security Act are post[-]traumatic stress disorder; diabetes mellitus, type II; hypertension; angina; hypercholesterolemia; and low back pain"; and that appellant had been disabled for SSA purposes since January 26, 1993. However, the Board discounts the materiality of the judge's decision insofar as the severity of appellant's service- connected psychiatric disability is concerned for the following reasons. First, the judge's decision does not in of itself constitute medical opinion/evidence. Second, the judge's decision considered the severity of the psychiatric disability in terms of the Social Security Act, not VA rating criteria. Third, the judge's decision appears based in large part upon that December 1993 statement from a VA psychiatrist, which reported that appellant had been disabled and unemployable since January 1993 on account of a psychiatric disability and non-service-connected disabilities, rather than solely on account of the service- connected psychiatric disability. Fourth, in the September 1994 SSA psychiatric assessment form signed by that judge, appellant was noted to have an anxiety disorder that resulted in only moderate restrictions of daily living activities and moderate social functioning difficulties. Fifth, the judge's decision was based, in part, upon a June 1994 written statement from Velda D. Pugh, M.D., which stated that appellant was disabled by physical and psychiatric disabilities. In a June 1994 SSA residual functioning questionnaire, Dr. Pugh indicated that appellant was not psychiatrically impaired with respect to interpersonal relationships, restriction of daily activities, or ability to perform work requiring frequent contact with others; and that the degree of constriction of appellant's interests was only mildly impaired. Sixth, the judge's decision was based, in part, upon a June 1993 written statement from Kamal Nagi, M.D., which stated that although appellant's mood was somewhat depressed, he was well-oriented; had no hallucinations/delusions or memory impairment; exhibited good judgment; watched television; and attended church and visited with friends. Significantly, a GAF Scale score of 60 was assigned. This GAF Scale score is indicative of a moderate, not severe, degree of psychiatric impairment. See Carpenter v. Brown, 8 Vet. App. 240, 242 (1995), wherein the Court explained that "GAF is a scale reflecting the psychological, social, and occupational functioning on a hypothetical continuum of mental health- illness.... A 55-60 rating indicates "moderate difficulty in social, occupational, or school functioning." See also, Cathell v. Brown, 8 Vet. App. 539 (1996); and Richard v. Brown, 9 Vet. App. 266, 267 (1996), wherein the Court stated that a "GAF of 50 is defined as ['][s]erious symptoms (e.g., suicidal ideation, severe obsessional rituals, frequent shoplifting) OR any serious impairment in social, occupational, or school functioning (e.g., no friends, unable to keep a job).[']" . A more recent VA psychiatric examination and social and industrial survey conducted in January 1995 reflect essentially similar findings as those reported on the 1993 VA psychiatric examination and social and industrial survey, except the severity thereof arguably appeared somewhat lessened. During this latter examination, appellant complained of anxiety, depression, flashbacks occurring 4 or 5 times per month, and physical problems. He had an anxious mood, appropriate affect, and was talkative. Psychomotor activity was normal. He was oriented, and his memory and other cognitive functions were intact. The examiner felt that appellant exaggerated his symptoms. Diagnoses included anxiety disorder; and a GAF scale score of approximately 60 was assigned. This is indicative of a moderate, not severe, degree of psychiatric impairment. See Carpenter; Cathell; and Richard, supra. Although a July 3, 1995 VA clinical record stated that appellant complained of severe nightmares, flashbacks, sleep difficulties, and intrusive thoughts and severe post- traumatic stress disorder was assessed, the actual clinical findings indicated that he was well-oriented with appropriate mood and good judgment. Additionally, VA clinical records reflect that in November 1995, appellant stated he was doing fine; that he was sleeping better although still getting up 3-4 times a night and having flashbacks of Vietnam; and that his nightmares had improved. In December 1996, appellant's condition was assessed as stable and a decrease in his Elavil was recommended. VA social work family counseling/mental health clinic records reveal that in April 1997, it was noted that although he was depressed at times, he was "able to handle it", that he was pleased with his present medication, and that he felt pretty good. In January 1998, appellant stated that he was doing well, that his medication was working, and that his depression was better. His sleep had improved. The assessment was that appellant was "doing well." Thus, the clinical evidence for the period prior to July 10, 1998 reveals that the appellant's psychiatric symptomatology was productive of moderate, not severe, social and industrial impairment. This degree of severity is reflective of no more than a 50 percent rating, since a 70 percent rating requires a severe degree of impairment. During the period between November 7, 1996 (date of the amended general rating formula for mental disorders) and July 10, 1998 (date of VA psychiatric examination upon which the RO increased the evaluation for the service-connected psychiatric disability from 50 percent to 70 percent), his psychiatric disability did not result in occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately, and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); and inability to establish and maintain effective relationships. The Board concludes that the examiner's opinion contained in the January 1995 VA psychiatric examination report, as to the severity of appellant's psychiatric disability, to be highly probative as to the severity of appellant's psychiatric disability during the period in question. The examiner reviewed the findings and compared the appellant's symptoms specifically to the objective criteria set forth in the GAF Scale, and determined that the overall severity of that disability was no more than moderate. Said examination and more recent clinical records during the period prior to July 10, 1998 primarily indicate that appellant's psychiatric disability resulted in no more than moderate social and industrial inadaptability. Said examination and more recent clinical records during the period prior to July 10, 1998 reflect that appellant's psychiatric disability was not manifested primarily by suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near- continuous panic or depression affecting the ability to function independently, appropriately, and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); and inability to establish and maintain effective relationships. Thus, the Board concludes that an evaluation in excess of 50 percent for appellant's psychiatric disability prior to July 10, 1998 is not warranted. 38 U.S.C.A. § 1155; 38 C.F.R. §§ 4.7, 4.129, 4.130, 4.132, Diagnostic Codes 9203, 9400, 9411. Rating disabilities is not an exact science, as indicated by the Schedule for Rating Disabilities: The percentage ratings represent as far as can practicably be determined the average impairment in earning capacity resulting from such diseases and injuries and their residual conditions in civil occupations. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disabilities. 38 C.F.R. § 4.1. The clinical evidence does not show that prior to July 10, 1998, the appellant's psychiatric disability, in and of itself, presented such an exceptional or unusual disability picture with related factors as marked interference with employment or frequent periods of hospitalization as to render impractical the application of the regular schedular standards, as is required for an extraschedular evaluation, for the aforestated reasons. 38 C.F.R. § 3.321(b)(1). Since the preponderance of the evidence is against allowance of an evaluation in excess of 50 percent for said disability prior to July 10, 1998, the benefit-of-the-doubt doctrine is inapplicable with respect to this issue. 38 U.S.C.A. § 5107(b) (West 1991). II. An Effective Date Earlier than July 10, 1998 for an Evaluation in Excess of 70 Percent for the Service-Connected Psychiatric Disability Appellant contends, in essence, that an effective date earlier than July 10, 1998 for the assignment of a 70 percent evaluation for his psychiatric disability should be awarded. It is argued that the effective date should be at least January 1993, on the grounds that that was date of an initial claim. It is also contended that the revised VA regulations pertaining to rating mental disorders, effective November 7, 1996, constitute a liberalizing VA issue under 38 C.F.R. § 3.114. The effective date of an award of increased compensation shall be the earliest date as of which it is ascertainable that an increase in disability had occurred, if application is received within one year of such date; otherwise, it is the date of receipt of claim. 38 U.S.C.A. § 5110(b)(2); 38 C.F.R. § 3.400(o)(2). A recent Precedent Opinion of the VA General Counsel, O.G.C. Prec. Op. No. 12-98 (Sept. 23, 1998), held that (1) since 38 C.F.R. § 3.400(q)(1)(i) states that, when new and material evidence is received within the appeal period or prior to an appellate decision, the effective date "will be as though the former decision had not been rendered", the statutory provision and regulations governing the effective date of an original claim for increased rating, 38 U.S.C.A. § 5110(a) and 38 C.F.R. § 3.400, must be applied; and (2) the effective date for an increased rating based upon new and material evidence submitted during the appeal period or prior to an appellate decision is the date on which the facts establish the increase occurred or the date of the original claim for increase, whichever is later. It is reiterated that after a September 1989 Board decision affirmed a noncompensable rating for appellant's service- connected psychiatric disability, he reopened his claim for a compensable rating for the service-connected psychiatric disability on October 3, 1989. Appellant timely appealed an October 23, 1989 rating decision, which denied entitlement to an increased (compensable) rating for the service-connected psychiatric disability. In a December 1995 decision, the Board granted restoration of a 50 percent rating for appellant's psychiatric disability on the grounds that an unappealed rating decision of March 1979 (confirmed by an August 1979 rating determination) was clearly and unmistakably erroneous; and granted service connection for post-traumatic stress disorder. A January 1996 implementing rating decision increased the rating for the service- connected psychiatric disability from 30 percent to 50 percent, effective June 1, 1979. In a September 1998 rating decision, the RO granted an increased rating for appellant's variously diagnosed psychiatric disability, including paranoid schizophrenia with post-traumatic stress disorder, from 50 percent to 70 percent, effective July 10, 1998. Appellant has been in continuous prosecution of his appeal of that October 1989 rating decision. As the Board explained in detail in Part I of the decision herein, it was not factually ascertainable that appellant's service-connected psychiatric disability more nearly resulted in at least severe social and industrial inadaptability or more nearly resulted in social and industrial inadaptability with deficiencies in most areas, prior to July 10, 1998. Thus, as the RO indicated in its September 1998 rating decision sheet, the earliest date appellant's service- connected psychiatric disability was factually ascertainable as resulting in more nearly severe social and industrial inadaptability or social and industrial inadaptability with deficiencies in most areas was on the July 10, 1998 VA psychiatric examination. Since the date that severe psychiatric disability was initially factually ascertainable, July 10, 1998, was subsequent to the date of claim for increase, the July 10, 1998 date controls. 38 U.S.C.A. §§ 1155, 5110(b)(2) and 38 C.F.R. § 3.400(o)(2) and (q)(1)(i). Parenthetically, even assuming arguendo that the revised VA regulations pertaining to rating mental disorders, effective November 7, 1996, constitute a liberalizing VA issue under 38 C.F.R. § 3.114, this would not warrant an effective date earlier than July 10, 1998 for the assignment of a 70 percent evaluation for appellant's psychiatric disability, since 38 C.F.R. § 3.114(a) requires, in pertinent part, that "[w]here...compensation...is awarded or increased pursuant to a liberalizing law or VA issue which became effective on or after the date of its enactment or issuance, in order for a claimant to be eligible for a retroactive payment under the provisions of this paragraph the evidence must show that the claimant met all eligibility criteria for the liberalized benefit on the effective date of the liberalizing law or VA issue and that such eligibility existed continuously from that date to the date of claim or administrative determination of entitlement." In short, for the period prior to July 10, 1998, appellant did not meet the "eligibility criteria for the liberalized benefit" (i.e., the rating criteria for at least a 70 percent evaluation for the service-connected psychiatric disability as set forth in the revised VA regulations pertaining to rating mental disorders) for the period prior to July 10, 1998. Since the preponderance of the evidence is against allowance of an effective date earlier than July 10, 1998 for the assignment of a 70 percent evaluation for appellant's psychiatric disability for the aforestated reasons, the benefit-of-the-doubt doctrine is inapplicable with respect to this issue. 38 U.S.C.A. § 5107(b). ORDER An evaluation in excess of 50 percent for a variously diagnosed psychiatric disability, including paranoid schizophrenia with post-traumatic stress disorder, for the period prior to July 10, 1998, and an effective date earlier than July 10, 1998 for an evaluation in excess of 70 percent for the service-connected psychiatric disability are denied. MICHAEL D. LYON Member, Board of Veterans' Appeals