Citation Nr: 0002766 Decision Date: 02/03/00 Archive Date: 02/10/00 DOCKET NO. 94-38 580 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Huntington, West Virginia THE ISSUES 1. The propriety of the initial 30 percent rating for Post- Traumatic Stress Disorder (PTSD) for the period preceding September 26, 1998. 2. The propriety of the initial 50 percent rating for PTSD for the period beginning September 26, 1998. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States WITNESSES AT HEARING ON APPEAL Appellant, G. H. ATTORNEY FOR THE BOARD W. R. Steyn, Associate Counsel INTRODUCTION The veteran had active military service from May 1969 to March 1971. This appeal arises before the Board of Veterans' Appeals (Board) from a March 1994 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Huntington, West Virginia, which granted the veteran entitlement to service connection for PTSD and assigned an initial 30 percent rating effective October 4, 1993. By rating decision dated January 1999, the RO increased the veteran's initial rating for PTSD to 50 percent effective September 26, 1998. The veteran's claim was before the Board in March 1997 and March 1998, at which times it was remanded for additional development. The Board noted in its March 1998 remand that the issue of whether the veteran's income was excessive for receipt of improved disability pension benefits was in appellate status, and had not been withdrawn by the veteran. However, in a July 1998 statement by the veteran, he clarified that he did not wish to file for pension eligibility. Accordingly, this issue is withdrawn. FINDINGS OF FACT 1. All relevant information necessary for an equitable disposition of the appeal has been developed. 2. Based on the evidence from October 4, 1993, to the present, the veteran has severe symptoms due to his PTSD; his ability to establish and maintain effective or favorable relationships with people is severely impaired. 3. Based on the evidence from October 4, 1993, to the present, the veteran's PTSD is productive of occupational and social impairment; however, there is not total occupational and social impairment due to such symptoms as gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. 4. Based on the evidence from October 4, 1993, to the present, the veteran's PTSD does not render him virtually isolated in the community and is not productive of totally incapacitating psychoneurotic symptoms bordering on gross repudiation of reality. 5. Based on the evidence from October 4, 1993, to the present, the veteran has not been unable to retain employment due to his PTSD. CONCLUSION OF LAW An initial rating of 70 percent for PTSD for the period from October 4, 1993, to the present is appropriate. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. § § 4.132, Diagnostic Code 9411(old diagnostic criteria in effect prior to November 7, 1996); 4.130, Diagnostic Code 9411 (new diagnostic criteria in effect as of November 7, 1996). REASONS AND BASES FOR FINDINGS AND CONCLUSION Background A copy of an operative report from the Charleston Area Medical Center was submitted from April 1992. Pre-operative and post-operative diagnoses were penetrating wound with foreign body embedded into the brain. A copy of a physician's summary from the West Virginia Department of Human Services was submitted from May 1992, diagnosing the veteran with traumatic brain injury. Length of time or disability was described as permanent. Regarding employment limitations, the physician wrote no employment at this time. The veteran underwent a VA examination in February 1994. The veteran complained of nervousness and depression. He noted an accident in 1992 which left him paralyzed. He described nightmares, and indicated that he was hypervigilant. His wife stated that the veteran was a workaholic, and coped with his PTSD as a consequence by working. The veteran noted that he was extremely moody and irritable. Examination showed that the veteran was neat and cooperative. He was alert and oriented for time, place, date, and person. He was able to recall the last two presidents, but could not do serial sevens. Marked anger and irritability were noted. The examiner stated that the veteran's memory was poor, especially for recent events. No auditory or visual hallucinations were elicited. He was guarded and suspicious. It was noted that a sense of helplessness and hopelessness prevailed. He stated that he could not remember better when he was less depressed and anxious. He did not have any active suicidal or homicidal ideation. No bizarre thoughts, tangentiality, or circumstantial thinking were elicited. His insight into his problems seemed to be fair. Diagnoses were organic affective syndrome, post-traumatic; and PTSD, moderate, worsened by the organic affective syndrome; and right hemiparesis with difficulty walking as a consequence. It was noted that the veteran definitely needed to continue outpatient psychiatric treatment. Psychological testing to assess the degree of organicity was recommended. The veteran underwent a VA examination in January 1995. It was noted that the veteran had been unemployed since April 1992 because of brain injury. Relevant diagnoses were PTSD, and right sided paralysis secondary to brain surgery from a foreign body in 1992, complicated by right-sided paralysis. The veteran underwent a VA examination in February 1995. It was noted that the veteran had worked in the coal mines for 20 years until he got hurt in 1992. The veteran indicated that he was on edge most of the time. He stated that he was easily startled. He stated that he had a tendency to sit and dwell on things since he did not have much to do. He did not like being around people. He had recurrent nightmares. He stated that he felt depressed, and had hopeless, helpless feelings. He stated that he was easily irritable, and got angry and upset. He stated that he had rage-like episodes. He stated that he had problems coping with stress, and felt frustrated because he could not express himself. He stated that he would get very suspicious and paranoid. Examination showed that the veteran had right hemiparesis and expressive aphasia. He was oriented for time, place, and person. Attention and concentration were impaired. He could not do routine mental calculations. His memory and recall for recent events was impaired. He was able to recall only one out of five objects after five minutes. There was no evidence of looseness of associations, flight of ideations, or pressured speech. There were no obsessive thoughts or compulsive actions. He denied being actively suicidal or homicidal. Diagnoses were PTSD and status post head injury with right hemiparesis. Highest GAF score in the past year was noted to be 50. The examiner stated that the veteran continued to have problems with PTSD, but that a serious head injury with expressive aphasia and right hemiparesis had made his problems worse. The veteran underwent a VA examination in July 1997. The examiners stated that they reviewed the C file. The veteran reported that he stopped working in 1992 because of a mining accident. He reported a history of exaggerated startle response. He reported a history of intrusive day thoughts, and indicated that he had an explosive temper. He described being verbally and physically aggressive. He complained of nightmares five times a week. He reported isolating himself on a regular basis. He noted a history of hypervigilance, and indicated that he felt paranoid at times and insecure. He indicated that he had very few friends. It was noted that the veteran was taking psychiatric medication. He appeared for the examination casually groomed. He answered all questions readily. His motor activity and gait were noted with a limp and a walker. His quality of speech was normal and relevant, although at times it was barely audible, slurred, and slowed. He was oriented to person, place, and time. His memory appeared to be intact; however his remote memory appeared to be slightly impaired. His mood was dysphoric, as he appeared depressed and anxious. His affect was flat. His GAF score was approximately 60 to 65. The examiner stated that the veteran appeared to be moderately affected by PTSD and organic brain syndrome in terms of gainful employment. Diagnoses were PTSD; dementia due to head injury; and organic brain syndrome, per client report. He reported a history of suicidal and homicidal ideation, but denied any current suicidal or homicidal ideation. He denied any psychotic symptoms. His impulse control appeared to be contained. His insight and judgment appeared to be fair. The veteran submitted copies of VA Medical Center treatment records from 1993 to 1998. They show that the veteran received increasing amounts of psychiatric medication during this time. In October 1995, it was noted that the veteran avoided most people including friends. Diagnosis was PTSD, moderately severe to severe in nature. In October 1996, the veteran was diagnosed with PTSD, moderately severe to severe in nature. In May 1997, the veteran was diagnosed with PTSD, moderately severe to severe in nature associated with major depression; severe adjustment disorder with anxious and depressed mood secondary physical and situational factors; seizure disorder, post traumatic, poorly controlled, and personality change following head injury. In July 1997, the veteran was diagnosed with PTSD moderately severe to severe in nature; associated major depression, recurrent, moderately severe to severe in nature; adjustment disorder with anxious and depressed mood, secondary to physical and situational factors; seizure disorder, post-traumatic, poorly controlled at times; and personality change following head injury. The veteran underwent a VA examination in September 1998. It was noted that the C file was reviewed. The veteran complained of an inability to express himself, and depression and anxiety. He did not want to be around any people or noise. He would get extremely short-tempered and agitated, and did not want to be around people or noise, especially the VFW meetings, which he stopped attending, and had enjoyed in the past. It was noted that the veteran was on medication which he got from the VA Medical Center. The veteran stated that he had not worked since 1992. He stated that when he worked, he had been able to keep himself busy, and keep his mind occupied. It was noted that the veteran's relationship with his wife was fair. The veteran stated that he preferred to be alone, and that he could only be with people for a short time. He stated that he rarely went to church, and became extremely jumpy at sudden noises. Examination showed that the veteran had expressive aphasia. He was oriented for time, place, date, and person, but attention and concentration were poor. He was having a hard time coping. His memory was poor, and had worsened since his head injury in the mines. He thought that everyone around him was after him, and got very paranoid. His abstract thinking was poor and showed concretization. No auditory or visual hallucinations were elicited. He was guarded and suspicious. No active homicidal or suicidal plans were entertained, but he felt that life was not worth living at times. He stated that he felt useless. His insight and judgment into problems was poor. His memory and recall was basically for short term. He did not have any particular hobbies or interests, and did not belong to any club or organization. He needed help with activities of daily living, including bathing and changing clothes. He had weakness of the right side with right hemiparesis. Diagnosis was PTSD, moderately severe to severe; adjustment disorder with anxious and depressed mood secondary to physical illness and situational factors; associated major depression, recurrent, moderate to moderately severe in nature. The examiner noted that the veteran sustained a head injury in 1992 and suffered dementia from that with short- term memory loss, seizures, post-traumatic right-sided hemiparesis, and expressive aphasia. GAF was 50 to 55. The examiner noted that the veteran definitely needed to continue outpatient psychiatric treatment. Supervised living conditions were recommended. Church activities and calisthenics, and periodic visits by family and church personnel, including friends, was strongly recommended to deal with loneliness. The veteran was afforded a videoconference hearing before a Board member in September 1999, a transcript of which has been associated with the claims folder. He testified that he had dreams and intrusive thoughts because of his PTSD. He stated that he did not have friends, and some of the ones that he did have were merely those who helped him get around when he had to. He stated that he would lose it if he went into a crowd, and that he had a hard time maintaining his composure. He stated that his children just stayed out of his way. The veteran's wife testified that he jumped if there was a sudden noise. He stated that he had suicidal thoughts, but did not have homicidal thoughts, or thoughts about hurting people. He stated that he was verbally abusive, and sometimes physically abusive to people. He stated that he was on medication for PTSD, including Prozac, Valium, and Trazadone, and that it helped to some degree. He stated that he sought treatment at the VA Medical Center, and went to a psychiatrist every 2-3 months. The veteran agreed that his emotions caused him to be "out of whack" all the time and to lose it easily. His wife stated that the veteran was dealing with his physical disabilities better than his mental ones. It was noted that the veteran had been in an accident that left his right arm and leg paralyzed, and a head injury. Analysis The veteran has had examinations and been rated under both sets of applicable rating criteria for psychiatric disabilities. He has been rated under the new diagnostic criteria for PTSD effective November 7, 1996, and under the old diagnostic criteria for PTSD in effect prior to November 7, 1996. Therefore, the RO has considered all of the criteria applicable to the veteran's claim. Karnas v. Derwinski, 1 Vet.App. 308, 313 (1991). The new general rating formula for mental disorders to include PTSD, under 38 C.F.R. § 4.130, Diagnostic Code 9411, effective November 7, 1996, are as follows: A 100 percent disability rating is in order when there is total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. A 70 percent disability rating is in order when there is occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation, obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances ( including work or a worklike setting); inability to establish and maintain effective relationships. A 50 percent disability rating is in order when there is 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. A 30 percent disability rating is in order when there is occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events). The general rating formula for psychoneurotic disorders, to include PTSD, under 38 C.F.R. § 4.132, Diagnostic Code 9411, in effect prior to November 7, 1996, were as follows: A 100 percent disability rating is assigned when the attitudes of all contacts except the most intimate are so adversely affected as to result in virtual isolation in the community. Totally incapacitating psychoneurotic symptoms bordering on gross repudiation of reality with disturbed thought or behavioral processes associated with almost all daily activities such as fantasy, confusion, panic and explosions of aggressive energy resulting in profound retreat from mature behavior. Demonstrably unable to obtain or retain employment. A 70 percent disability rating is assigned when the ability to establish and maintain effective or favorable relationships with people is severely impaired. The psychoneurotic symptoms are of such severity and persistence that there is severe impairment in the ability to obtain or retain employment. A 50 percent disability rating is assigned when the ability to establish or maintain effective and wholesome relationships with people is considerably impaired. By reason of psychoneurotic symptoms the reliability, flexibility and efficiency levels are so reduced as to result in considerable industrial impairment. A 30 percent disability rating is assigned when there is definite impairment in the ability to establish or maintain effective and wholesome relationships with people. The psychoneurotic symptoms result in such reduction in initiative, flexibility, efficiency and reliability levels as to produce definite industrial impairment. The Court has held that if any one of the three independent criteria contained in Diagnostic Code 9411 in effect prior to November 7, 1996, is met, a 100 schedular evaluation is required under that code. Johnson v. Brown, 7 Vet. App. 95, 99 (1994). When the only compensable service-connected disability is a mental disability, and such mental disorder precludes a veteran from securing or following a substantially gainful occupation, the mental disorder shall be assigned a 100 percent schedular evaluation under the appropriate diagnostic code. 38 C.F.R. § 4.16 (c) (1996). When there is a question as to which of two evaluations shall be assigned, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. As noted on the cover page and in the introduction of this document, the RO assigned two separate initial ratings regarding the veteran's PTSD. The RO assigned an initial 30 percent rating for PTSD for the period preceding September 26, 1998, and an initial 50 percent rating for PTSD for the period beginning September 26, 1998. In Fenderson v. West, 12 Vet. App. 119 (1999), the Court distinguished between a veteran's dissatisfaction with the initial rating assigned following a grant of service connection and a claim for an increased rating of a service- connected condition. In Fenderson, the Court agreed that the rule from Francisco v. Brown, 7 Vet. App. 55, 58 (1994) ("Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is of primary importance.") was not applicable where the veteran was expressing dissatisfaction with the initial rating assigned. The Court also held that at the time of an initial rating, separate ratings can be assigned for separate periods of time based on the facts found, a practice known as staged ratings. Fenderson v. West, 12 Vet. App. 119, 126 (1999) The RO in effect assigned two separate staged ratings regarding the veteran's PTSD. Both of these staged ratings are in appellate status. The veteran claims that the initial staged ratings assigned for his service-connected disability were not proper. These claims are "well grounded" within the meaning of 38 U.S.C.A. § 5107(a). All of the evidence following the grant of service connection (not just the evidence showing the present level of disability) must be considered in evaluating the veteran's claim. The RO did consider all of the evidence following the grant of service connection, so the veteran's claims are in appropriate appellate status. As will be described below, the veteran's two initial staged ratings for his PTSD (30 percent for the period preceding September 26, 1998, and 50 percent for the period beginning September 26, 1998) both warrant 70 percent initial ratings. For the period preceding September 26, 1998, there are numerous VA outpatient treatment records from 1995 to 1997 showing that the veteran was diagnosed with PTSD, moderately severe to severe in nature. In determining whether the veteran's PTSD was predominantly severe or moderately severe during the time he was seen as an outpatient, under 38 U.S.C.A. § 5107 (b), the benefit of the doubt is to be given to the veteran. Accordingly, it is determined that the veteran's PTSD was predominantly severe when he was treated as an outpatient from 1995 to 1997. The outpatient treatment records and VA examinations from this time also show that the veteran had symptoms such as nightmares, suspiciousness, and increasing isolation, and that he was treated with increasing amounts of psychiatric medication. Accordingly, with the finding that the veteran's PTSD was severe coupled with the symptomatology described above, it is determined that the veteran's psychoneurotic symptoms were of such severity such that his ability to establish and maintain effective or favorable relationships with people was severely impaired. In summary, the evidence shows psychiatric findings enough to approximate the criteria for a 70 percent rating under Diagnostic Code 9411 under the old diagnostic criteria for the period preceding September 26, 1998. For the period beginning September 26, 1998, the veteran underwent a VA examination in September 1998 at which time he was diagnosed with PTSD, moderately severe to severe. Like the determination for the rating for the period preceding September 26, 1998, under 38 U.S.C.A. § 5107 (b), the benefit of the doubt is to be given to the veteran in regard to whether his PTSD was predominantly severe or moderately severe. Accordingly, it is determined that the veteran's PTSD was predominantly severe for the period beginning September 26, 1998. This finding coupled with the findings from the September 1998 VA examination showing agitation, suspiciousness, and wanting to be alone, are enough to show that the veteran's psychoneurotic symptoms were of such severity such that his ability to establish and maintain effective or favorable relationships with people was severely impaired. In summary, the evidence shows psychiatric findings enough to approximate the criteria for a 70 percent rating under Diagnostic Code 9411 under the old diagnostic criteria for the period beginning September 26, 1998. As the evidence shows that the veteran's initial disability rating was 70 percent disabling for the period preceding September 26, 1998, and 70 percent for the period beginning September 26, 1998, the analysis of whether the veteran's initial staged ratings warrant a higher rating than 70 percent will be combined into one analysis. The evidence does not support an initial rating higher than 70 percent for the veteran's PTSD. Under the new diagnostic criteria, for the veteran to receive a 100 percent initial rating, the evidence must show that the veteran has total occupational and social impairment due to various symptoms noted above. Regarding those symptoms, the evidence does not show that the veteran has had gross impairment in thought processes or communication due to his PTSD. While the evidence shows that the veteran has impairment in thought processes and communication, the evidence shows that such impairment is due to the head injury that the veteran suffered in 1992. At the veteran's July 1997 VA examination, the examiner diagnosed the veteran with dementia due to head injury. Similarly, at the veteran's September 1998 VA examination, the examiner stated that the veteran suffered from dementia with expressive aphasia from his head injury in 1992. The evidence does not show that the veteran has had persistent delusions or hallucinations. At the veteran's February 1994 and September 1998 VA examinations, the veteran did not have auditory or visual hallucinations. The evidence also does not show that the veteran has had grossly inappropriate behavior. Regarding being a persistent danger of hurting himself or others, there is both positive and negative evidence regarding this question. At the veteran's February 1994 VA examination, while marked anger and irritability were noted, there was no suicidal or homicidal ideation. At the veteran's February 1995 VA examination, while the veteran stated that he had rage like episodes, he denied being actively suicidal or homicidal. At the veteran's July 1997 VA examination, while the veteran indicated that he had an explosive temper, his impulse control appeared to be contained, and he denied current suicidal or homicidal ideation. At the veteran's September 1998 VA examination, he stated that he did not have active suicidal or homicidal plans. At the veteran's September 1999 hearing, he stated that he was sometimes physically abusive, and had suicidal thoughts, but not homicidal thoughts. The evidence does not show that the veteran has been intermittently unable to perform activities of daily living (including maintenance of minimal personal hygiene) because of his PTSD. The evidence shows that the veteran needs help with activities of daily living, including bathing and changing clothes, but that such need is because of right- sided paralysis. Regarding disorientation to time and place, at the veteran's VA examinations in February 1994, February 1995, July 1997, and September 1998, the veteran was oriented to time and place. Regarding memory loss, it is true that the veteran has memory loss; however his memory loss has been attributed to his 1992 head injury. At the veteran's September 1998 VA examination, the examiner stated that the veteran had dementia and short- term memory loss from his 1992 head injury. Even if it is conceded that the veteran is in persistent danger of hurting others because of his PTSD, the clear weight of the evidence shows that the veteran has not met any of the other criteria necessary for a higher initial rating of 100 percent under the new diagnostic criteria for PTSD. In summary, the evidence does not show that the veteran has had total occupational and social impairment due to the symptomatology described in the new diagnostic criteria at any point from the grant of service connection to the present. Under the old diagnostic criteria, for the veteran to receive a 100 percent initial rating, the evidence must show either that the veteran's attitudes of all contacts except the most intimate are so adversely affected as to result in virtual isolation in the community; or that the veteran has totally incapacitating psychoneurotic symptoms bordering on gross repudiation of reality with disturbed thought or behavioral processes associated with almost all daily activities such as fantasy, confusion, panic and explosions of aggressive energy resulting in profound retreat from mature behavior; or that the veteran is demonstrably unable to obtain or retain employment. While the evidence shows that the veteran has not been working, the evidence does not show that the veteran is unemployed because of his PTSD. It needs to be emphasized that the veteran's initial rating needs to be made solely on the manifestations from his PTSD. The medical evidence shows that the veteran worked for 20 years in the mines until 1992, when he sustained a traumatic head injury from a mining accident. A physician's summary from May 1992 (shortly after the veteran's injury to his head), shows that the examiner diagnosed the veteran with traumatic brain injury and determined that the veteran could not work. Similarly, at the veteran's July 1997 VA examination, the veteran stated that he stopped working in 1992 because of a mining accident. Accordingly, the evidence does not show that the veteran has been unable to obtain or retain employment because of his PTSD. Likewise, the evidence does not show that the veteran has had totally incapacitating symptoms bordering on gross repudiation of reality. As noted in the above discussion, there is no question that the veteran has significant symptomatology stemming from his PTSD. However, at the veteran's VA examinations, he was always oriented to time and place. Also, he never had auditory or visual hallucinations. While the veteran has described rage like episodes, an explosive temper, and being verbally abusive and sometimes physically abusive, such symptoms can not be accurately be described as "totally incapacitating." Likewise, the evidence does not show that the veteran is virtually isolated in his community due to the attitudes of his contacts being so adversely affected by his PTSD. The evidence shows that the veteran is not close to many people. At his July 1997 VA examination, he stated that he had very few friends, and at his September 1998 VA examination, he stated that he had stopped attending VFW meetings because he did not wish to be around people or noise, and that he did not belong to any club or organization. At his hearing in September 1999, the veteran testified that he did not have friends, but then stated that some of the ones that he did have, were merely those who helped him get around when he had to. There is no question that the veteran isolates himself more since the mining accident. However, the veteran has indicated that he does have some friends. Accordingly, even though the veteran is not close to many people, the evidence shows that the veteran is not "virtually isolated in the community." In summary, the clear weight of the evidence shows that the veteran has not met any of the criteria necessary for an initial evaluation of 100 percent disabling under the old diagnostic criteria for PTSD for any point from the grant of service connection to the present. Accordingly, under the criteria of Diagnostic Code 9411, effective November 7, 1996 and under the criteria of Diagnostic Code 9411, effective prior to November 7, 1996, and the provisions of 38 C.F.R. § 4.7, a 70 percent initial rating, but no higher, is warranted for the period from October 4, 1993, to the present. This case does not present 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). In reaching the determination, consideration has been given to the provisions of 38 C.F.R. Parts 3 and 4, whether or not they were raised by the veteran, as required by Schafrath v. Derwinski, 1 Vet.App. 589 (1991). Specifically, the RO ordered special VA examinations to determine the severity of the veteran's PTSD. The record is complete with records of prior medical history and rating decisions. Therefore, the RO and the Board have considered all the provisions of Parts 3 and 4 that would reasonably apply in this case. ORDER The initial rating assigned for PTSD is increased to 70 percent for the period from October 4, 1993, to the present. G. H. SHUFELT Member, Board of Veterans' Appeals