Citation Nr: 0001827 Decision Date: 01/21/00 Archive Date: 01/28/00 DOCKET NO. 96-14 269 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUE Entitlement to a total rating due to individual unemployability based upon service-connected disabilities. REPRESENTATION Appellant represented by: F. Bill Darden, Attorney at Law ATTORNEY FOR THE BOARD C. L. Krasinski, Counsel INTRODUCTION The veteran served on active duty from January 1968 to April 1970. Service records show that he was awarded three Purple Hearts and a Combat Action Ribbon. This matter came before the Board of Veterans' Appeals (the Board) on appeal from a rating decision of the St. Petersburg, Florida, Department of Veterans Affairs (VA) Regional Office (RO). This matter was remanded to the RO in October 1997. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of this appeal has been obtained. 2. Prior to December 1, 1999, the veteran's service- connected disabilities included anxiety neurosis and post traumatic stress disorder which was 70 percent disabling from April 19, 1993; shrapnel wound to the right leg with retained foreign body which was 10 percent disabling from July 2, 1973; pulmonary tuberculosis moderately advanced, inactive, which was 10 percent disabling from January 19, 1977; shell fragment wound to the soft tissue of the skull which was zero percent disabling from July 2, 1973; and post-concussion with headaches which was zero percent disabling from November 4, 1975. The veteran's combined disability evaluation was 80 percent, effective April 19, 1993. 3. The veteran has a GED and completed one year of college; he reported that he last worked full-time in 1983 as a postal worker. 4. The veteran's service-connected disabilities, when evaluated in association with his educational attainment and occupational experience, are not sufficiently disabling to render him unable to obtain and retain all kinds of substantially gainful employment. 5. Effective December 1, 1999, the veteran's service- connected disabilities include anxiety neurosis and post traumatic stress disorder which is 50 percent disabling from April 19, 1993; shrapnel wound to the right leg with retained foreign body which is 10 percent disabling from July 2, 1973; pulmonary tuberculosis moderately advanced, inactive, which is 10 percent disabling from January 19, 1977; shell fragment wound to the soft tissue of the skull which is zero percent disabling from July 2, 1973; and post-concussion with headaches which is zero percent disabling from November 4, 1975. The veteran's combined disability evaluation was 60 percent, effective December 1, 1999. 6. There is no probative evidence demonstrating that the veteran has experienced frequent periods of hospitalization or marked interference with employment due to his service- connected disabilities. 7. The veteran is not unemployable solely because of his service-connected disabilities. CONCLUSION OF LAW The criteria for the award of a total rating for compensation based upon individual unemployability have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 3.321, 3.340, 3.341, 4.15, 4.16 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSION Initially, the Board notes that the veteran's claim is well- grounded within the meaning of 38 U.S.C.A. § 5107(a). That is, he has presented a claim which is plausible. Murphy v. Derwinski, 1 Vet. App. 78 (1990). This matter was remanded to the RO in October 1997. The Board is satisfied that all relevant facts have been properly developed and the RO complied with the directives in the remand. The veteran was afforded VA examinations in December 1994 and October 1998. Pertinent treatment records, that were identified by the veteran, were obtained. No further assistance is required to comply with the duty to assist the veteran mandated by 38 U.S.C.A. § 5107(a). Pertinent Law and Regulations All veterans who are shown to be unable to secure and follow a substantially gainful occupation by reason of service- connected disability shall be rated totally disabled. Total disability will be considered to exist when there is present any impairment of mind or body which is sufficient to render it impossible for the average person to follow a substantially gainful occupation. 38 C.F.R. § 3.340 (1999). If the total rating is based on a disability or combination of disabilities for which the Schedule for Rating Disabilities provides an evaluation of less than 100 percent, it must be determined that the service-connected disabilities are sufficient to produce unemployability without regard to advancing age. 38 C.F.R. § 3.341 (1999). Total disability ratings for compensation may be assigned where the schedular rating is less than total when the disabled person is, in the judgment of the rating agency, unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities, provided that, if there is only one such disability, this disability shall be ratable at 60 percent or more, and if there are two or more disabilities, there shall be at least one disability ratable at 40 percent or more and sufficient additional disability to bring the combined rating to 70 percent or more. See 38 C.F.R. § 4.16(a) (1999). In evaluating total disability, full consideration must be given to unusual physical or mental effects in individual cases, to peculiar effects of occupational activities, to defects in physical or mental endowment preventing the usual amount of success in overcoming the handicap of disability and to the effects of combinations of disability. 38 C.F.R. § 4.15 (1999). Entitlement to a total rating due to individual unemployability must be established solely on the basis of impairment from service-connected disabilities and not based on nonservice-connected disabilities or advancing age. 38 C.F.R. § 4.19 (1999); Hodges v. Brown, 5 Vet. App. 375, 378- 379 (1993). The sole fact that a claimant is unemployed or has difficulty obtaining employment is not enough. And, although a high rating in itself is a recognition that the impairment makes it difficult to obtain and keep employment, the question remains whether the veteran is capable of performing the physical and mental acts required by employment, not whether the veteran can find employment. See 38 C.F.R. § 4.16(a); Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). In Hatlestad v. Derwinski, 1 Vet. App. 164 (1991), the United States Court of Appeals for Veterans Claims (formerly the Court of Veterans Appeals) (Court) referred to apparent conflicts in the regulations pertaining to individual unemployability benefits. Specifically, the Court indicated there was a need for discussing whether the standard delineated in the controlling regulations was an "objective" one based on average industrial impairment or a "subjective" one based upon the veteran's actual industrial impairment. The Board is bound in its decisions by the regulations, the Secretary's instructions and the precedent opinions of the chief legal officer of VA. 38 U.S.C.A. § 7104(c) (West 1991). In a pertinent precedent decision, the VA General Counsel concluded that the controlling VA regulations generally provide that veterans who, in light of their individual circumstances, but without regard to age, are unable to secure and follow a substantially gainful occupation as a result of service-connected disability shall be rated totally disabled, without regard to whether an average person would be rendered unemployable by the circumstances. Thus, the criteria include a subjective standard. It was also determined that "unemployability" is synonymous with inability to secure and follow a substantially gainful occupation. VA O.G.C. Prec. Op. No. 75-91 (Dec. 27, 1991). The determination of whether a total disability rating is warranted is to be based on review of the entire evidence of record and the application of all pertinent regulations. See Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Once the evidence is assembled, the Secretary is responsible for determining whether the preponderance of the evidence is against the claim. If so, the claim is denied; if the evidence is in support of the claim or is in equal balance, the claim is allowed. See Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). Analysis In a February 1995 rating decision, the RO denied entitlement to a total rating based upon individual unemployability due to service-connected disabilities. The RO determined that the veteran was not found to be unable to secure or follow a substantially gainful occupation as a result of service- connected disabilities and that the veteran was capable of gainful employment. Entitlement to a total rating prior to December 1, 1999 Prior to December 1, 1999, the threshold percentage requirements, which are set forth in 38 C.F.R. § 4.16, were met in this case. The veteran's service-connected disabilities included anxiety neurosis and post traumatic stress disorder which was 70 percent disabling from April 19, 1993; shrapnel wound to the right leg with retained foreign body which was 10 percent disabling from July 2, 1973; pulmonary tuberculosis moderately advanced, inactive, which was 10 percent disabling from January 19, 1977; shell fragment wound to the soft tissue of the skull which is zero percent disabling from July 2, 1973, and post-concussion with headaches which is zero percent disabling from November 4, 1975. The veteran's combined disability evaluation was 80 percent, effective April 19, 1993. Thus, the percentage requirements set forth under 38 C.F.R. § 4.16(a) have been met. See 38 C.F.R. § 4.16(a) (1999). The Board finds that the evidence of record does not establish that the veteran was unable to secure or follow a substantially gainful occupation as a result of his service- connected disabilities prior to December 1, 1999. The veteran filed his claim for entitlement to a total rating based upon individual unemployability due to service connection disabilities in 1994. He contends that he is unemployable as a result of his service-connected anxiety neurosis and post traumatic stress disorder. He asserts that the medications that he takes for his service-connected post traumatic stress disorder and anxiety neurosis have rendered him unable to obtain or retain employment. The veteran contends that he last worked in 1983 for the post office. He states that he had to leave that job and other jobs due to his service-connected psychiatric disorder. The evidence of record establishes that the veteran obtained a GED and completed one year at a community college. He also attended approximately one year of culinary school. After service, he worked for a car rental business, as a salesman, and as a clerk for two governmental agencies. A March 1997 psychosocial report indicates that the veteran reported that his last and longest job ended in 1983, when he was a postal worker for three years. The evidence of record establishes that the veteran has not been gainfully employed since that time. The Board finds that the evidence of record does not establish that the veteran's service-connected neurosis and post traumatic stress disorder renders the veteran unable to secure or follow a substantially gainful occupation. The Board finds that the probative and persuasive medical evidence of record establishes that the veteran's service- connected anxiety neurosis and post traumatic stress causes moderate occupational impairment and the medication improves the symptoms. The veteran underwent a VA examination in October 1998 and the Board finds this examination report to be very probative. The October 1998 VA psychiatric examination report indicates that the veteran had been treated in the past with Haldol and Desyrel. Examination revealed that the veteran's speech was relevant, coherent, and logical. He was oriented times three and there were no deficits in memory of recent or remote events. He abstracted proverbs adequately. Affect was somewhat bland but appropriate. The veteran's fund of knowledge was adequate. The Axis I diagnosis was post traumatic stress disorder and history of poly-substance abuse. The Axis II diagnosis was antisocial personality disorder. His current Global Assessment of Functioning (GAF) score was 60; the GAF score for the past year was 60. The Court has held that GAF scores are a scale reflecting the "psychological, social, and occupational functioning on a hypothetical continuum of mental health- illness." See Carpenter v. Brown, 8 Vet. App. 240, 242 (1995); Richard v. Brown, 9 Vet. App. 266 (1996) (citing the American Psychiatric Association's DIAGNOSTIC AND STATISTICAL MANUAL FOR MENTAL DISORDERS (4th ed.), p. 32). GAF scores ranging between 61 to 70 reflect some mild symptoms (e.g., depressed mood and mild insomnia) or some difficulty in social, occupational, or school functioning (e.g., occasional truancy, or theft within the household), but generally functioning pretty well, and has some meaningful interpersonal relationships. Scores ranging from 51 to 60 reflect more moderate symptoms (e.g., flat affect and circumstantial speech, occasional panic attacks) or moderate difficulty in social, occupational, or school functioning (e.g., few friends, conflicts with peers or co-workers). Scores ranging from 41 to 50 reflect serious symptoms (e.g., suicidal ideation, severe obsessional rituals, frequent shoplifting) or any serious impairment in social, occupational or school functioning (e.g., no friends, unable to keep a job). As noted above, the October 1998 VA examination report indicates that the veteran's GAF score was 60, which reflects moderate difficulty in occupational functioning. The Board finds the October 1998 VA examination report to be highly probative,. The veteran was examined by an expert who considered the veteran's prior medical history, including his history of substance abuse. Furthermore, the examination findings are supported by evidence of record. VA hospitalization records, dated in May 1994, indicate that the veteran was not competent, but he was employable. The discharge diagnoses were polysubstance abuse and psychosis, not otherwise specified. There is no indication that the veteran was treated for post traumatic stress disorder or anxiety neurosis. The hospitalization records indicate that the veteran was admitted voluntarily from the emergency room with complaints of hearing voices and feeling suicidal. He had complaints of flashbacks and complained of homicidal and suicidal ideation. The veteran also reported that he had been engaging in the use of crack cocaine and he admitted to some alcohol intake. Drug testing was positive for cocaine. He was started on Haldol for thought disorder and paranoid delusions. It was later determined that the veteran was guilty of grand theft auto and he had actually missed a court date, which was the date he presented to the hospital. It was noted that upon discharge, the veteran was not competent to handle his funds and he was employable. Treatment records from a correctional institute, dated from May 1994 to July 1994, indicate that the veteran was prescribed medication. A July 1994 treatment record indicates that the veteran was stable. An April 1996 psychiatric assessment, for a correctional institute, indicates that the veteran reported that his post traumatic stress disorder symptoms were infrequent and were helped by medication. The psychiatric assessment indicates that the veteran reported having infrequent flashbacks from Vietnam; he has not had any in a few weeks. He stated that medication helped his sleep and flashbacks. The veteran denied having hallucinations, suicide attempts, delirium tremens, or manic episodes. Mental status examination revealed that the veteran was oriented and organized. A psychosis was not observed. His mood and affect was pleasant but flat when he talked about flashbacks. He denied having suicidal or homicidal ideation. The diagnosis was post traumatic stress disorder, no acute exacerbation. Treatment records from a correctional institute, dated from April 1996 to February 1997, indicate that the veteran continued a regimen of medication and was stable. A February 1997 treatment record indicates that the veteran had no side effects from the medication. An addiction center evaluation interview, dated in March 1997, indicates mental status examination revealed that the veteran did not appear to have any gross neurological or physical abnormalities. He was well-groomed and dressed. Affect was somewhat blunted, with a stable mood state. He denied ideas of suicide or homicide and auditory or visual hallucinations. No delusions were elicited. Thought processes were goal directed, with no bizarre thought content. Intelligence appeared to be within average range with a fair general fund of information. Ability to count and calculate was good. Judgment in a hypothetical setting was good. Insight into his problems was good. The Axis I diagnosis was alcohol dependence, cocaine dependence, and post traumatic stress disorder. His current GAF was 45 and his GAF for the past year was 65. A March 1997 psychosocial report from an addiction center indicates that the veteran denied having current post traumatic stress disorder symptoms because his medications were working. The veteran indicated that he did have post traumatic stress disorder and he had intrusive thoughts of his traumatic experiences. He reported having nightmares and flashbacks, which were intermittent and he tried to suppress them. He had a rather restricted affect. He indicated that he received medication while in jail and stated that it was helpful. Mental status examination revealed that the veteran was casually and appropriately dressed. His affect was restricted. The veteran denied any current anxiety because he believed his medications were working well. He denied any depression. His speech was clear and coherent. He denied any bizarre thoughts, hallucinations, obsessions or compulsions, delusions, or thoughts to harm self or others at the present time. He indicated that he had tactile and visual hallucinations when he used crack. He also indicated that he had delusions when on drugs. His general fund of knowledge and memory was good. His concentration seemed good. His judgment seemed good. The examiner concluded that the veteran met the criteria for cocaine dependence, alcohol dependence, and cannabis dependence. It was noted that the veteran had given up social, occupational, and recreational activities and continued his substance abuse despite negative consequences. The examiner also indicated that the veteran met the criteria for post traumatic stress disorder based upon his having experienced very traumatic events and he stated that he had intrusive recollections of the traumas, nightmares, and flashbacks. He demonstrated restricted affect and he avoided thoughts of the experiences and avoided people. The diagnosis was cocaine dependence, polysubstance dependence by history, and post traumatic stress disorder. The evidence of record indicates that the veteran had undergone VA psychiatric and psychological examinations in December 1994. A December 1994 VA psychiatric examination report indicates that he reported that he was not in any active treatment at that time. He has been taking Haldol since 1994. Mental status examination revealed that the veteran was cooperative and he made good eye contact. His speech was at a normal rate, relevant, and coherent. His affect was blunted and his mood appeared somewhat sad. He denied suicidal or homicidal ideation or any symptoms consistent with psychosis. The veteran was oriented times three. His ability to abstract was somewhat concrete and his social judgment was somewhat impaired. The assessment was post traumatic stress disorder, severe. He appeared competent for VA purposes. A December 1994 VA psychological examination report indicates that the veteran stated that he wanted medication to stop him from hearing and seeing things. He indicated that he had blackouts, during which he attacked family members. During the clinical interview, the veteran stated that he persistently re-experienced combat episodes in dreams and flashbacks (usually at night). He was distressed at reminders of these events. He avoided stimuli associated with combat or war. He had a decreased interest in significant activities and increased feelings of detachment. The veteran had persistent symptoms of arousal, including insomnia, outburst of anger, hypervigilence, and physiologic reactivity. The psychologist stated that although the veteran's cognitive abilities remained intact, his post traumatic stress disorder (with a periodic exacerbation of symptoms), rendered the veteran incapable of consistently managing his personal and financial affairs. The diagnosis was post traumatic stress disorder. The Board notes that the December 1994 VA psychiatric examination determined that the veteran's symptoms were severe. The Board points out that there was no indication in the examination report that the veteran was unemployable. The VA psychological examination report indicates that the veteran was incapable of consistently managing his personal and financial affairs due to the post traumatic stress disorder. This examination report did not indicate whether the veteran's substance abuse affected his ability to manage his affairs. The Board finds that these examination reports have limited probative value, since the examiners did not address the veteran's long history of substance abuse, which the evidence of record shows, causes considerable impairment in the veteran's ability to obtain or retain employment. As noted above, the May 1994 hospitalization records reflect a diagnosis of polysubstance abuse and psychosis, not otherwise specified. Drug testing was positive for cocaine. It is not clear if the veteran was still abusing substances in December 1994, when these examinations were performed. Thus, the Board finds these medical opinions to have limited probative value. See Owens v. Brown, 7 Vet. App. 429 (1995). The veteran also asserts that he is precluded from securing or following a substantially gainful occupation due to the side effects of the medication that he takes for his service- connected post traumatic stress disorder. The Board points out that the veteran has not submitted any medical evidence to support this contention. In fact, as discussed above, the veteran has reported that the medication has helped to control his post traumatic stress disorder symptoms. A treatment record from a correctional institute, dated in February 1997, indicates that that the veteran had no side effects from the medications and he was stable. The Board also points out that probative and persuasive evidence of record establishes that the veteran has not secured or followed substantially gainful employment for the past 12 years due to polysubstance abuse and incarceration due to convictions for various crimes. The evidence of record shows that the veteran became unemployable when his drug use escalated in the mid 1980's. The evidence of record further shows that the veteran has been incarcerated on numerous occasions. He was incarcerated in January 1994, May 1994 to August 1994, and July 1996 to February 1997. He has currently been incarcerated since October 1997. He is expected to be released in March 2001. The veteran has reported that his arrests began in 1984, when he started to use crack cocaine. He indicated that he has been arrested for shoplifting, stolen vehicles, possession, and loitering; he has been arrested twenty or more times for driving with a suspended license. The Board further points out that there is evidence of record which establishes that the veteran left the postal worker position because he did not want to work long hours, not because of his post traumatic stress disorder or the anxiety neurosis. An April 1984 VA examination report indicates that the veteran reported that he had been working for a federal agency for the past two months. Prior to that, he worked for the post office. He indicated that the post office wanted him to work 60 hours a week and he could not do that. The Board finds the April 1984 VA examination report to be highly probative, since this record, with the veteran's statements, was made contemporaneous to the time the veteran left the postal worker position, as opposed to being made twenty years later. The Board finds that the veteran's other service-connected disabilities are not particularly disabling from an industrial standpoint. Review of the record reveals that prior to December 1, 1999, service connection was in effect for shrapnel wound to the right leg with retained foreign body which was 10 percent disabling from July 2, 1973; pulmonary tuberculosis moderately advanced, inactive, which was 10 percent disabling from January 19, 1977; shell fragment wound to the soft tissue of the skull which was zero percent disabling from July 2, 1973; and post-concussion with headaches which was zero percent disabling from November 4, 1975. The Board notes that these disabilities have been stable for almost 20 years. There is no medical evidence of record which shows that the veteran has sought medical treatment for these disabilities or that such disabilities preclude him from securing or following substantially gainful employment. The Board points out that the May 1994 VA hospitalization records indicated that the physical examination of the veteran, except for his teeth, was unremarkable. A March 1997 addiction center evaluation indicates that the veteran denied having any serious medical or surgical illness, other than treatment for tuberculosis in 1970. The Board notes that the medical evidence of record establishes that the veteran's tuberculosis was currently inactive. In light of these medical findings, the Board concludes that the veteran is capable of some sort of gainful employment, such as a clerk, when considering only his service-connected disabilities. The evidence of record shows that the veteran's post traumatic stress disorder and anxiety neurosis causes moderate occupational impairment and his symptoms improve with medication. The evidence of record shows that the veteran has a GED and one year of college education. He also has work experience as a clerk, postal worker, and salesman. There is no medical evidence of record which establishes that his service-connected disabilities preclude him from securing or following all forms of employment. The evidence of record establishes that the veteran has been precluded from employment since the mid 1980's due to polysubstance abuse and incarceration. On longitudinal review of the pertinent evidence of record, the Board does not find that the veteran's service-connected disabilities prevent all forms of substantially gainful employment for which he is qualified. Therefore, the veteran's claim for entitlement to a total rating based on individual unemployability due to service-connected disabilities is denied. 38 U.S.C.A. § 5107(b); 38 C.F.R. §§ 3.340, 3.341, 4.16(a). Entitlement to a total rating after December 1, 1999 Effective December 1, 1999, the veteran's service-connected disabilities included anxiety neurosis and post traumatic stress disorder which is 50 percent disabling from April 19, 1993; shrapnel wound to the right leg with retained foreign body which is 10 percent disabling from July 2, 1973; pulmonary tuberculosis moderately advanced, inactive, which is 10 percent disabling from January 19, 1977; shell fragment wound to the soft tissue of the skull which is zero percent disabling from July 2, 1973, and post-concussion with headaches which is zero percent disabling from November 4, 1975. The veteran's combined disability evaluation was 60 percent, effective December 1, 1999. Since December 1, 1999, the threshold requirements, set forth in 38 C.F.R. § 4.16(a), have not been met. Since the veteran has not met the percentage requirements set forth in 38 C.F.R. § 4.16(a), the Board will proceed with consideration of entitlement to an extraschedular evaluation under the provisions of 38 C.F.R. § 4.16(b). 38 C.F.R. § 4.16(b) states that rating boards should submit to the Director, Compensation and Pension Service, for extraschedular consideration all cases of veterans who are unemployable by reason of service-connected disabilities, but who fail to meet the percentage standards set forth in 38 C.F.R. § 4.16(a). The rating board, in accordance with 38 C.F.R. § 4.16(b), will include a full statement as to the veteran's service-connected disabilities, employment history, education and vocational attainment and all other factors having a bearing on the issue. An extraschedular evaluation may be approved provided the case presents such an exceptional or unusual disability picture, with such related factors as marked interference with employment or frequent periods of hospitalization. See 38 C.F.R. § 3.321(b)(1) (1999). As noted above, the veteran asserts that he is unemployable due to his service-connected post traumatic stress disorder and anxiety neurosis. Review of the record reveals that in August 1999, the RO reduced the disability evaluation for post traumatic stress disorder and anxiety neurosis from 70 percent to 50 percent effective December 1, 1999. The service-connected post traumatic stress disorder and anxiety neurosis anxiety neurosis is rated under the provisions of Diagnostic Code 9411, post traumatic stress disorder. See 38 C.F.R. § 4.130, Diagnostic Code 9411 (1999). Under the provisions of 38 C.F.R. § 4.130, Diagnostic Code 9411, a 50 percent disability evaluation is warranted for 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; or difficulty in establishing and maintaining effective work and social relationships. 38 C.F.R. § 4.130, Diagnostic Code 9411. The RO assigned a 50 percent evaluation to the service- connected post traumatic stress disorder and anxiety neurosis based upon medical evidence which establishes that this disorder had improved. As discussed above, the veteran underwent a VA examination in October 1998. Examination revealed that the veteran's speech was relevant, coherent, and logical. He was oriented times three and there were no deficits in memory of recent or remote events. He abstracted proverbs adequately. Affect was somewhat bland but appropriate. The veteran's fund of knowledge was adequate. The Axis I diagnosis was post traumatic stress disorder and history of poly-substance abuse. The veteran's current GAF score and his GAF score for the past year was 60. Additional medical evidence of record establishes that the veteran's post traumatic stress disorder symptoms were intermittent and that such symptoms improved with medication. The RO determined that the 50 percent evaluation adequately compensated the veteran for his impairment due to post traumatic stress disorder and anxiety neurosis, and the RO did not submit the veteran's case submission to the Director of the Compensation and Pension Service for extraschedular consideration. Service connection is also in effect for shrapnel wound to the right leg with retained foreign body. A 10 percent evaluation is assigned effective July 2, 1973, under Diagnostic Code 5312, injury to muscle group XII. 38 C.F.R. § 4.73, Diagnostic Code 5312 (1999). Service connection is also in effect for pulmonary tuberculosis moderately advanced, inactive. A 10 percent evaluation is assigned effective January 19, 1977 under Diagnostic Code 6731, tuberculosis, pulmonary, chronic, inactive. 38 C.F.R. § 4.97, Diagnostic Code 6731 (1999). Service connection is in effect for shell fragment wound to the soft tissue of the skull and a zero percent evaluation is assigned effective July 2, 1973 under Diagnostic Code 5296. 38 C.F.R. § 4.72, Diagnostic Code 5296 (1999). Service connection is also in effect for post-concussion with headaches and a zero percent evaluation is assigned under Diagnostic Code 8045, brain disease due to trauma. 38 C.F.R. § 4.124a, Diagnostic Code 8045 (1999). The RO's failure to submit the case to the Director of the Compensation and Pension Service for extraschedular consideration is reasonable because there are no exceptional factors or circumstances associated with the veteran's disablement. There is no evidence showing that the veteran's service- connected psychiatric and physical disabilities markedly interfere with his ability to be employed other than that contemplated within the schedular standards. There is no evidence of record showing that the veteran's service- connected disabilities present an unusual or exceptional disability picture or require frequent periods of hospitalization. The medical evidence of record shows that the veteran's psychiatric symptoms improved with medication. His physical disabilities are not particularly disabling from an industrial standpoint. In fact, the medical evidence establishes that his service-connected physical disabilities have been stable for over twenty years. There is no evidence that the veteran has been recently treated or hospitalized for such disability and the veteran does not allege otherwise. Thus, the Board concludes that the veteran is ineligible for an extraschedular consideration of these service-connected disabilities in accordance with 38 C.F.R. § 4.16(b). Therefore, the veteran's claim for entitlement to a total rating based on individual unemployability due to service- connected disabilities is denied. 38 U.S.C.A. § 5107(b); 38 C.F.R. §§ 3.340, 3.341, 4.16(a). ORDER Entitlement to a total disability rating based upon individual unemployability is denied. THOMAS J. DANNAHER Member, Board of Veterans' Appeals