BVA9504623 DOCKET NO. 91-44 416 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Indianapolis, Indiana THE ISSUES 1. Entitlement to an increased evaluation for post-traumatic stress disorder (PTSD), currently evaluated as 30 percent disabling. 2. Entitlement to a total disability rating based on individual unemployability by reason of service-connected disability. REPRESENTATION Appellant represented by: The American Legion WITNESS AT HEARING ON APPEAL Veteran ATTORNEY FOR THE BOARD Suzie St. Vil, Associate Counsel INTRODUCTION The veteran had active military service from September 1968 to September 1970. He has been represented since 1990 by The American Legion. This matter came before the Board of Veterans' Appeals (hereinafter Board) on appeal from a February 1991 rating decision, of the Indianapolis, Indiana Regional Office (RO), which granted service connection for post-traumatic stress disorder. The RO assigned a 30 percent disability rating for the veteran's PTSD, effective July 13, 1988. The notice of disagreement with this rating percentage was received in May 1991. In April 1992, the Board remanded the case to the RO for further development. The appeal was received back at the Board in May 1992. In October 1992, the Board again remanded the case to the RO for development of the issue of entitlement to a total disability rating based on individual unemployability. Thereafter, by a rating action of February 1993, the RO confirmed its prior denials of the veteran's claim for an increased rating for PTSD; in this rating action, it was also determined that the PTSD symptomatology was not of such severity that the veteran was unemployable due solely to his PTSD. A supplemental statement of the case was issued in March 1993. In March 1994, the Board once again remanded the case to the RO for still further development. Medical records were received from the Social Security Administration in July 1994. Subsequently, a rating action of August 1994 confirmed the previous denials of the veteran's claim for an increased rating for PTSD. By a rating decision of September 1994, the RO denied the veteran's claim for a total disability rating based on individual unemployability. A notice of disagreement with the denial of a total rating based on individual unemployability was received in October 1994. A supplemental statement of the case was issued later in October 1994. A letter from the veteran received in November 1994 will be construed as a substantive appeal with respect to the issue of entitlement to a total rating based on individual unemployability. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends, in effect, that he is entitled to an increased evaluation for his service-connected PTSD. It is maintained that the veteran's disorder presents a greater degree of impairment than is currently reflected by the assigned rating. The veteran points out that his PTSD requires regular treatment, which includes counseling and medication therapy. The veteran maintains that, prior to entering military service, he was a well adjusted person; however, since his return home from combat duty, a manifested psychiatric impairment has adversely affected his ability to successfully interrelate with others, causing severe industrial inadaptability and prolonged periods of unemployment. The veteran argues that the initial February 22, 1991 rating action, which awarded a 100 percent evaluation for his PTSD, was a better reflection of the severity of his service-connected disorder. In addition, the service representative points out that the recent VA examination report of October 1992 indicates that the veteran's psychiatric impairment seemed to "prevent him from functioning in a substantial manner in employment." The service representative further argues that it is extremely difficult to distinguish the nonservice-connected schizoaffective disorder from the veteran's service-connected PTSD, as many of the symptoms are closely related. He further argues that the amount of compensation which a veteran would receive should not be considered a governing factor in assessing the level of the disability, or the rating which should be assigned for that disability. Therefore, it is argued that a total disability rating based on individual unemployability is warranted. It is requested that the veteran be accorded the benefit of the doubt. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991), has reviewed and considered all of the evidence and material of record in the veteran's claims file. 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 the veteran's claims for an increased rating for PTSD and a total disability rating based on individual unemployability. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the veteran's claim has been obtained by the RO. 2. Service connection is in effect only for PTSD, rated as 30 percent disabling. 3. The veteran's service connected PTSD is currently manifested by nightmares, flashbacks, intrusive thoughts of Vietnam, and exaggerated startle response, productive of no more than definite social and industrial impairment. 4. The veteran has completed 3 years of college, and has occupational experience as a computer programmer and counselor; although he has had periods of part-time employment, he was last employed on a regular, full-time basis in 1976. 5. The veteran's service connected disorder, alone, does not preclude all forms of substantially gainful employment. CONCLUSIONS OF LAW 1. The criteria for an evaluation in excess of 30 percent for PTSD have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. § 4.7, Part 4, Code 9411 (1993). 2. The criteria for a total disability rating based on individual unemployability are not met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 3.340, 3.341, 4.16 and Part 4 (1993). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Initially, we note that we have found that the veteran's claims are "well-grounded" within the meaning of 38 U.S.C.A. § 5107(a); effective on and after September 1, 1989. That is, we find that he has presented claims which is plausible. Moreover, after careful review of the evidentiary record, we are also satisfied that all relevant facts have been properly developed. Therefore, no further assistance to the veteran is required to comply with the duty to assist as mandated by 38 U.S.C.A. § 5107(a). Some of the basic facts are not in dispute. Service medical records indicate that the veteran served as an indirect fire crewman while stationed in Vietnam. The certificate of discharge or release from active duty (DD Form 214) revealed that the veteran received the National Defense Service Medal, the Vietnam Service Medal, and the Vietnam Campaign Medal. The veteran's personnel file extracts also reveal that he received a Combat Infantryman Badge. Of record are VA hospital records covering the period from October 1978 to September 1980, which reflects that the veteran was admitted to a VA hospital on a temporary commitment in October 1978 with a diagnosis of chronic undifferentiated schizophrenia manifested by inappropriate affect, flight of ideas, auditory hallucinations, selective attention to mathematics, and impairments in judgment and insight. The veteran participated in recreation therapy, occupational therapy, corrective therapy, and social skills. The records reflect that the veteran was readmitted at a VA hospital in July 1979 with complaints of difficulty getting along with his family, as well as an increase in auditory and visual hallucinations. He was again afforded occupational and corrective therapy. The discharge diagnoses were chronic undifferentiated schizophrenia and disposition with occupational problems. Received in October 1988 were VA hospital discharge summaries, as well as outpatient treatment notes, covering the period from October 1978 to April 1988. The records show that the veteran was admitted to a hospital in October 1978 on temporary commitment, following an incident in which he broke several windows in his sister's home and was arrested for disorderly conduct. The veteran was given a diagnosis of chronic undifferentiated schizophrenia manifested by inappropriate affect, flight of ideas, hallucinations, selective attention to mathematics, as well as impairments of judgment and insight. It was noted that the veteran improved on recreational, occupational and corrective therapy as well as social skills. Subsequent periods of hospitalization show that the veteran was admitted following frequent outbursts of anger and violence usually directed towards the female members of his family. During an admission in July 1979, the veteran admitted to smoking marijuana on occasions. The findings were essentially the same as those reported during the October 1978 hospitalization. The diagnosis was chronic schizophrenia. Hospital reports for the early 1980's demonstrate that the veteran continued to be admitted to the hospital on emergency detentions, due to hostile behavior which usually resulted in his arrest for disorderly conduct. These records reflect that the veteran's behavior and exacerbation of his symptoms were usually precipitated by his noncompliance with medications prescribed, and failure to report to the mental health clinic for follow-up evaluations; medications included Haldol and Thorazine. The records show that the veteran was readmitted to the hospital by his parents, in January 1984, who became concerned because of bizarre behavior and preoccupation with electronic gadgets. On admission, it was reported that the veteran was hostile and agitated, but not physically assaultive; he was put in seclusion and medicated with Thorazine, which was effective. It was noted that the veteran calmed down and became friendly and cooperative, although he was still preoccupied with electronics and computers. The attending physician reported that, after one week, the veteran's preoccupation subsided. The discharge diagnosis was schizophrenia, chronic, paranoid type, in remission. The records reflect the veteran voluntarily reported to the mental health clinic in March 1988 for evaluation after he became very paranoid about having his personal belongings stolen; he stated that people were "casing" his apartment. During hospitalization, it was reported that the veteran presented no behavior management problem, but did manifest manic-like behavior on the ward, such as pressured speech and euphoria. The discharge diagnosis was bipolar disorder, manic. Received in November 1989 was a statement from the veteran, wherein he indicated that he had no psychiatric disorder prior to entry into military service. The veteran reported that his pattern of antisocial behavior began in 1971; he stated that the pressures of his job began to trigger dreams of Vietnam, which included a "headless" friend and someone else stepping on a mine. The veteran stated that he began suffering nervous breakdowns in 1974 when the kids set off firecrackers, which sounded like incoming artillery. He related that these nervous breakdowns had also destroyed his concentration. The veteran indicated that he also suffered from flashbacks, most of which had disappeared. He stated that he still had flashbacks of an incident which occurred when the vehicle in which a company member was riding hit a mine, throwing him 15 feet into the air; he noted that that soldier died on impact. He also stated that this particular flashback had been recurring for the past 15 years. The veteran further related that Vietnam films were very difficult for him to watch. Received in March 1990 was the report of a VA compensation examination, conducted in connection with a claim for service connection for PTSD, wherein the examining psychiatrist indicated that the veteran had been followed at the clinic with a diagnosis of bipolar affective disorder. It was noted that the veteran had a history of multiple substance abuse, and problems with alcohol abuse and noncompliance with medication. The psychiatrist reported that the veteran had no history of problems until 1975; since then, he had had approximately 30 psychiatric hospitalizations. It was noted that the veteran also had a history of episodic cannabis abuse, with a past history of LSD. It was reported that the veteran spent his time reading, watching television, working with telescope and keyboard, playing chess, and visiting friends. He reporting working part time, but he indicated that he had never held a job for more than a few months at a time. Current medications included Lithium and Haldol. On mental status evaluation, the veteran was oriented, with a good mood, almost euphoric. The psychiatrist reported that the veteran's speech was pressured with some flight of ideas, and was circumstantial. His speech was not well directed; as a result, the psychiatrist was unable to determine what the veteran's goals were. It was noted that the veteran was only superficially logical, but that such was not serious enough to be a thought disorder. He was not suicidal or homicidal; insight was minimal, and judgment was fair. The diagnoses were bipolar mood disorder, chronic, hypomanic; and history of alcohol abuse and mixed substance abuse, in remission. The veteran was examined by the VA in August 1990 for the purpose of determining whether he had PTSD. At that time, the veteran reported that he began experiencing auditory hallucinations and talking to himself in Vietnam; he thought everyone around him was a devil and trying to control him. He related that, on one incident, while he was with the 11th Armored Cavalry Regiment, one of his best friends had his head blown off by a grenade launcher. The veteran reported that, on yet another occasion, one of the captains of the squad moved out front, hit a land mine, whereupon his whole body blew up into the air and he died instantly. The veteran reported that this particular incident had been the cause of recurrent dreams. The veteran stated that he was reminded of Vietnam by any type of loud noises, causing him to dive onto the floor for cover; he stated that those noises to him sound like incoming mortar shells. It was reported that the veteran had a history of chronic schizophrenia, paranoid type, since the 1970's, with multiple hospitalizations and police action. It was further reported that the veteran was also violent and threatening; his last hospitalization in 1988 reported a final diagnosis of bipolar disorder, manic. It was further noted that the veteran was doing pretty well on outpatient care and had not needed commitment. The veteran indicated that he was very antisocial and withdrawn. It was noted that he was receiving Social Security benefits; reportedly the veteran had "no plans to look for a job." On mental status evaluation, the veteran was described as cooperative, but overly talkative. The examiner stated that speech was not pressured; he also stated that excessive talking was a feature of narcissism. The examiner further stated that, initially, the veteran's affect seemed a bit blunted, but he became quite personable and was able to joke appropriately; he was not sad or excessively anxious. The veteran admitted to hearing voices in the past, but not at present. His intelligence was at least average. The examiner observed that the veteran was well oriented, with a fund of knowledge of recent events; his memory was intact. The veteran was not suicidal or homicidal at the time of the examination, but he had a well-documented history of being threatening and destructive in the past, requiring police action and commitment. The examiner stated that the veteran had the criteria for PTSD, with the experiencing of the traumatic events. The diagnoses were schizo-affective disorder with manic features; and PTSD, mild. The examiner further stated that the degree of psychiatric impairment was moderate to severe, with an inability to maintain meaningful and interpersonal relationships or employment. Received in January 1991 was a letter from the United States Army and Joint Services Environmental Support Group, dated in December 1990. It was noted that the morning reports confirmed that the veteran was assigned to Troop I, Third Squadron, 11th ACR from September 1969 to August 28, 1970. These reports revealed that Staff Sergeant Robert J. Nadeau was decapitated by shrapnel from a rocket-propelled grenade on November 25, 1969. The morning reports for the Third Squadron also show that a Captain Petrie assumed command of Troop I on June 25, 1970, and was killed the following day when he received fragmentation wounds. (Records from the Department of the Army--United States Army and Joint Services Environmental Support Group.) The veteran, accompanied by his representative, appeared and offered testimony at a hearing before a hearing officer at the RO in January 1991 in connection with his then pending claim for service connection for PTSD. The veteran's pertinent testimony is essentially reflected in the contentions section above. The veteran reported that he had been in and out of mental institutions for the past 20 years. The veteran explained that, at one point he perceived the police to be the Viet Cong, and was therefore engaged in a war against the police; however, he realized that the police served as he did in Vietnam in terms of putting their lives on the line. He further stated that he, in fact, was more scared of them than anything else. The veteran further indicated that he suffered from depression. By decision of February 1991, the VA Hearing Officer at the RO granted service connection for PTSD; a rating decision that month effectuated the decision and assigned a 30 percent rating. The veteran was afforded another VA compensation examination in July 1991. On mental status evaluation, it was indicated that the veteran appeared fairly ill-kempt; he was wearing a shirt that had on the front of it in three large letters "GUN." It was noted that he was cooperative with the interviewer, although somewhat guarded; his mood was "comprehensive." His affect was blunted. His thought process was illogical at times. The veteran stated that, when he is off his medication, he tends to be more irritable, and he does not get along well with people. He reported a history of auditory and visual hallucinations, but stated that he had not had any since he had been complying with his medications. The veteran reported frequent nightmares and intrusive thoughts about Vietnam. The veteran stated that he could not watch movies like Rambo. He stated that he only loved his mother; he had no other relationship except for one good friend. It was noted that the veteran had never been married. He denied any sleep problems or problems with concentration. He did report multiple problems expressing his anger. The examiner indicated that intelligence appeared to be within normal limits. The examiner indicated, however, that the veteran had no insight into his illness, except that he could state what it was. The diagnoses were schizo-affective disorder, moderate; PTSD, mild; and possible psychoactive substance abuse. The examiner reported that the degree of psychiatric impairment was moderate to severe from the schizo-affective disorder and "very mild" from the PTSD. The examiner also indicated that the veteran was competent to handle funds; he saw no reason why the veteran could not work part time, as he had done in the past. Attached to the above VA compensation examination was a PTSD diagnostic assessment completed by the examining physician. It was reported that the veteran reexperienced the traumatic events from Vietnam through nightmares and intrusive thoughts. The examiner confirmed a diagnosis of PTSD, but he stated that the disability is minimal from PTSD. The examiner further stated that the veteran had difficulty with relationships and employment; however, he observed that this was also probably due to schizo-affective disorder as well as probable substance abuse. In April 1992 the Board remanded this case to clarify questions advanced regarding the initial evaluation of PTSD by the RO's rating board as 100 percent disabling, subsequently changed to 30 percent. In response the veteran's accredited representative noted that someone from that service organization had reviewed and copied the February 22, 1991 rating action assigning a 100 percent rating within a few days after the rating. The RO's rating specialists noted that the revision of the schedular rating from 100 to 30 percent, which occurred prior to promulgation of the higher rating, did not result from any undue influence from adjudication management. The Adjudication Officer wrote that review of the veteran's award by the Assistant Adjudication Officer was undertaken in accordance with the Central Office Test Plan. That individual did not find that the rating of 100 percent was in accord with the August 1990 VA examination findings. The rating board was asked to review their earlier rating; subsequently the assigned rating was revised to 30 percent. It was noted further that the earlier rating decision had been destroyed and that the service representative who had represented the veteran was no longer employed by that service organization. The veteran was afforded a VA compensation examination in October 1992, for the specific purpose of evaluating PTSD. At that time he indicated that, as long as he used his medication his mood remained fairly stable; he also indicated that he no longer had any problems with inappropriate anger, hallucinations, or gross distortions of thought. The veteran indicated that he liked to read the comics, take long walks, exercise, watch TV, and he occasionally socialized with friends. The examiner indicated that the veteran "went on" a bit about his feelings of not being academically as bright as he used to be; he also stated that he was tired of being called "crazy" and not being able to fit in. On mental status evaluation, the veteran was described as fairly pleasant. His affect seemed somewhat blunted. The examiner observed that he was neither depressed nor euphoric. He showed some affective range, but overall his affect was slightly blunted. His thinking was somewhat tangential, but for the most part, he was fairly rational and logical. The examiner noted that there was no evidence of any delusions, bizarre content, or hallucinations. The veteran appeared to have average intelligence, and he seemed to have genuine insight into his illness and to employ good judgment. The diagnosis was schizoaffective disorder, bipolar type, also alcohol abuse and marijuana abuse by history. The examiner stated that the degree of psychiatric impairment was moderate to severe. The examiner further stated that it appeared that the veteran was quite bright and even had an academic leaning, but that his paranoia seemed to prevent him from functioning in a substantial manner; he also noted that the veteran did appear somewhat interpersonally more confident while on his current medications, but he did not appear to be employable. There were no references to symptoms of PTSD. A social and industrial survey was conducted by the VA in February 1993, at which time it was indicated that the veteran was casually attired, logical, oriented, and demonstrated good verbal skills. It was noted that he appeared in no acute distress, but warned that he was not always accountable "when people got on his nerves." The social worker reported that the veteran engaged in the interview willingly and established rapport easily. He demonstrated good verbal skills. He seemed to have a fatalistic outlook on life and projected low self esteem characteristics. It was noted that the veteran had an extensive mental health history which appeared to have improved somewhat due to compliance with medication and counseling. The veteran revealed past suicidal attempts, as well as former audio and visual hallucinations. The social worker concluded that, objectively, the social history included sufficient information to lend support to a diagnosis of PTSD; she stated, however, that the social history was developed primarily from the veteran's subjective reporting of past events. The veteran reported that he had not worked other than sparse employment since the 1970's, when he was terminated from employment due to nervous breakdowns caused by job pressures. He reported continued use of illegal drugs. Received in May 1993 was a private medical statement from D.B. Tarr, Ph.D., who examined the veteran in April 1993 for a private psychiatric clinic. At that time, the veteran reported a history of progressive deterioration on his mental status following his return from Vietnam in 1969. It was noted that, in addition to the veteran's psychiatric history, he reported numerous arrests for assault and battery; he also admitted to maintaining a series of relationships with women in which he was violent towards them either at their request or in exchange for payment. The veteran indicated that he was experiencing intrusive memories and flashbacks of combat experiences, many of which relate to fire fights which occurred while he was on patrol in the jungle. He also complained of exaggerated startle response and significantly impaired interpersonal relationships. Dr. Tarr stated that the veteran's symptoms were consistent with the diagnosis of PTSD, and that it was even the case that momentary hallucination-like experiences occurred in the course of flashbacks; however, he stated that the veteran's case was one that combined symptomatology of PTSD with that which was more typically associated with a thought disorder. The examiner further indicated that much of the veteran's history indicated bizarre ideation that was typically not associated with PTSD (i.e., having grandiose ideas about mathematical theories, claiming to watch a TV that is not turned on, and responding to ongoing auditory hallucinations). Dr. Tarr concluded that it would appear that the veteran demonstrated a symptomatological picture with an entrenched thought disorder with superimposed PTSD symptoms. The pertinent diagnoses were schizophrenia, paranoid, chronic; and PTSD. Received in July 1994 were records from the Social Security Administration. These records indicate that the veteran was found to be disabled as of August 30, 1978. It was determined that the medical evidence, mainly consisting of VA records, established that the veteran was permanently disabled due to chronic paranoid schizophrenia. Also received were additional VA medical records which cover the period from September 1978 to April 1994 and essentially show evaluation and treatment for chronic paranoid schizophrenia, drug abuse, noncompliance with medication, personality disorder and, most recently, manic depressive illness. On numerous occasions blood was drawn to monitor the level of Lithium. In December 1989, it was noted that the veteran continued to work at part- time jobs, although never more than a few months at any single place. Reportedly his current jobs netted him about $200 a week, which he stated helped him with the expense of dating; he reported no full-time employment for the last 7 - 10 years. In June 1991, the examiner noted that the diagnosis of PTSD was not confirmed; the veteran was alert, cooperative, humorous, with satisfactory mood, and appropriate affect. He denied hallucinations and had no suicidal ideas. The veteran was described as being in much better self-control than in previous years. In March 1993 the veteran reported that his major problem was limited funds, which hindered social interaction. He denied "thinking problems," depression, and homicidal and suicidal ideations; there was no evidence of psychotic thoughts. In December 1993, he was described as sequential and logical. He had poor eye contact but denied thought problems. He admitted to smoking marijuana. He was reported to be worried over finances. In May 1994 it was noted that he continued to be treated with medication for bipolar disorder and he exhibited symptoms of hypomania. Following mental status evaluation, the diagnoses were listed as: bipolar mood disorder; rule out schizophrenia; and rule out current substance abuse. The Board notes that the level of compensation benefits awarded for psychiatric disorders depends upon the degree of severity which is based upon the actual symptomatology as it affects the social and industrial adaptability. In evaluating the impairment caused by the psychiatric disorder, we are required to evaluate primarily those symptoms of abnormalities of conduct, judgment, and emotional reaction which produce impairment of earning capacity. 38 C.F.R. § 4.129. The Board further notes that, a 30 percent evaluation is warranted for post traumatic stress neurosis (post-traumatic stress disorder) when there is a definite impairment in the ability to establish or maintain effective and wholesome relationships with people and when psychoneurotic symptoms result in such reductions in initiative, flexibility, efficiency, and reliability levels as to produce definite industrial impairment. 38 C.F.R. Part 4, Code 9411. A 50 percent rating requires considerable impairment of social and industrial adaptability. In Hood v. Brown, 4 Vet.App. 301 (1993), the United States Court of Veterans Appeals (hereinafter Court) stated that the term "definite" in 38 C.F.R. § 4.132 (1993) was "qualitative" in character, whereas the other terms employed under that regulation to describe symptomatology for rating purposes were "quantitative" in character. To ensure that the Board meets the statutory requirement that it articulate "reasons or bases" for its decisions, the Court invited the Board to construe the term "definite" in a manner that would quantify the degree of impairment. 38 U.S.C.A. § 7104(d)(1) (West 1991). In a precedent opinion dated November 9, 1993, the General Counsel of VA held that the term "definite" under 38 C.F.R. § 4.132 (1993) is to be construed as "distinct, unambiguous, and moderately large in degree, more than moderate but less than rather large." O.G.C. Prec. 9-93 (Nov. 9, 1993). The Board is bound by precedent opinions issued by the VA General Counsel. 38 U.S.C.A. § 7104(c) (West 1991). Consequently, the Board will address the merits of the veteran's claim for an increased evaluation of his service- connected psychiatric disorder with this interpretation of "definite" in mind. In this regard, the Board notes that while the medical evidence demonstrates that the veteran reports symptoms of nightmares, intrusive thoughts and hostility as a result of his PTSD, the more comprehensive VA outpatient records make little or no mention of these symptoms or of PTSD. The recent clinical data does not demonstrate that the veteran's PTSD is productive of more than a "moderately large" social and industrial impairment. Contrary to the assertion advanced, the examiner during the July 1991 examination, stated that the degree of psychiatric impairment caused by the veteran's PTSD was very mild or minimal. The non- service connected schizoaffective disorder was reported to be moderately to severely disabling. In addition, it was indicated that the difficulty with relationships and employment was also probably due to his schizo-affective disorder as well as his substance abuse. The examiner noted that the veteran had shown an ability to work part-time (a fact borne out in the outpatient records) and there was no reason why he could not continue such employment. Again, a review of the extensive record of outpatient treatment received by the veteran indicates that he is being followed primarily for nonservice-connected psychosis, most recently diagnosed as bipolar disorder, which requires continued monitoring for Lithium levels. References to PTSD in the outpatient records are few. Following the most recent VA examination in October 1992, the only diagnosis reported was schizophrenia. Furthermore, in the report submitted by Dr. Tarr in May 1993, he noted that much of the veteran's history indicates bizarre ideation that is typically not associated with PTSD. The majority of the symptoms claimed by the veteran, to include auditory and visual hallucinations, have been found not to represent manifestations of his PTSD. There is no showing in the record that PTSD has ever required hospitalization or medication specifically for that disorder. The records suggest that the veteran's social and family relationships are impaired due to the impact of his psychosis. He admits, in the more recent VA outpatient records, that compliance with medication for his psychosis results in more positive dealings with others. In evaluating impairment resulting from ratable psychiatric disorders, social adaptability is to be evaluated as it affects industrial adaptability. The principle of social and industrial inadaptability as the basic criterion for rating disability from mental disorders contemplates those abnormalities of conduct, judgment and emotional reactions which affect economic adjustment, i.e. which produce impairment of earning capacity. 38 C.F.R. § 4.129 (1993). In order to attribute the veteran's poor adjustment in the work place to PTSD, the Board would have to ignore countless medical records which document that his industrial inadaptability has been linked directly to the symptoms associated with nonservice- connected psychosis, diagnosed as schizophrenia and currently as bipolar disorder, as well as his non-compliance with a prescribed medication regimen and the effects of illegal drug abuse. The more recent records show persuasively that with medication compliance, his symptoms improve. Although he has not reported steady employment for many years, there are a number of references to part-time work; on one occasion it being noted that he netted $200 weekly. During this time, it must be remembered that he was in receipt of Social Security disability, which may pose a disincentive to seeking employment. In this case, the entire evidence of record supports a determination that PTSD is no more than definitely disabling, that is, the record reasonably demonstrates social and industrial adaptability which is "more than moderate but less than rather large." The record does not reflect that there is "considerable" impairment. In exceptional cases where the schedular evaluations are found to be inadequate, an extraschedular evaluation commensurate with the average earning capacity impairment due exclusively to the service-connected disability or disabilities 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 as to render impractical the application of the regular schedular standards. 38 C.F.R. § 3.321(b)(1). As is obvious from the above medical evidence, there is no showing that such an unusual disability picture exists as regards PTSD. Therefore, an increased evaluation in excess of 30 percent for the veteran's PTSD is not warranted. With respect to the veteran's assertions regarding the initial evaluation of his PTSD as 100 percent disabling, the Board directs attention to the information recorded above, in response to the Board's request via the April 1992 remand. It remains unclear how the copy of the non-promulgated rating decision came into the possession of the service representative, who was then assisting the veteran. It appears that such action taken was within the discretion of the Adjudication Officer and the Board finds no basis upon which to overturn the promulgated rating decision. The Board notes that, entitlement to a total rating based on individual unemployability is predicated upon the evidence of record showing that the veteran is unemployable as the result of his service-connected disabilities. We must emphasize that the terms "unemployed" and "unemployable" are not synonymous, and that age is not for consideration in this determination. We also emphasize that a finding of unemployability must be based solely on service-connected disabilities. The medical evidence of record reflects that the veteran has received treatment primarily for schizo-affective disorder. As already noted above, the VA examination of October 1992 reported only one diagnosis of schizo-affective disorder, bipolar type. Moreover, the private medical statement from Dr. Tarr reported that the veteran demonstrated a symptomatological picture with an entrenched thought disorder and PTSD symptoms superimposed. Under these circumstances, the Board must conclude that, even if PTSD plays a part in the veteran's inability to obtain gainful employment, it is quite clear that his nonservice-connected schizo-affective disorder, which has been deemed to cause a moderate to severe degree of impairment, plays a major part of his difficulty. Despite contentions to the contrary, the VA and private examiners have been able to distinguish between the symptoms attributable to PTSD and those due to nonservice- connected psychosis. Thus, while the veteran's service connected disability may have an adverse effect on employability, the record does not show that it, alone, has resulted in the inability to obtain or maintain gainful employment. As a result, that benefit sought on appeal must be denied. In reaching this decision, the Board has considered the doctrine of granting the benefit of the doubt to the veteran but does not find the evidence is approximately balanced such as to warrant its application. 38 U.S.C.A. § 5107(b). ORDER An evaluation in excess of 30 percent for PTSD is denied. A total rating for compensation purposes based on individual unemployability by reason of service-connected disability is denied. N. R. ROBIN Member, Board of Veterans' Appeals The Board of Veterans' Appeals Administrative Procedures Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___ (1994), permits a proceeding instituted before the Board to be assigned to an individual member of the Board for a determination. This proceeding has been assigned to an individual member of the Board. (CONTINUED ON NEXT PAG NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991), 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 (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.