BVA9507718 DOCKET NO. 91-51 586 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Louisville, Kentucky THE ISSUES 1. Entitlement to service connection for drug abuse. 2. Entitlement to an earlier effective date than May 29, 1989 for the grant of service connection for post-traumatic stress disorder. 3. Entitlement to an increased rating for post-traumatic stress disorder, currently evaluated as 30 percent disabling. 4. Entitlement to an increased rating for right knee Osgood- Schlatter's disease, currently evaluated as 10 percent disabling. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD C. Lawson, Counsel INTRODUCTION The appellant, a veteran, served on active duty from August 1969 to November 1971. The Department of Veterans Affairs (VA) Louisville, Kentucky Regional Office (RO) denied the benefits sought. The appellant's claims have since been handled by the Nashville, Tennessee RO, which is currently in charge of his claims folder. The Board of Veterans' Appeals (Board) denied service connection for an acquired psychiatric disorder claimed as PTSD in May 1983. An application to reopen the claim for service connection was received on May 29, 1989. The Board remanded the case to the RO in March 1993. Since then, the RO reopened the claim for service connection and established service connection for post-traumatic stress disorder (PTSD), effective from May 29, 1989. Additionally, it awarded him a temporary total hospital rating pursuant to the provisions of 38 C.F.R. § 4.29 (1994) effective from April 2, 1993 through October 1993 in a January 1994 rating decision, in light of corresponding VA hospitalization for PTSD. CONTENTIONS OF APPELLANT ON APPEAL The appellant contends that service connection is warranted for drug abuse, as he abused drugs in service, and he also claims that it was caused by punishment in service and/or by his service-connected right knee and/or PTSD disabilities. Next, he argues that an increased rating is warranted for PTSD and his right knee disability, as they are more disabling than reflected by the ratings assigned. He has had surgery on his right knee, and has difficulty walking and pain which increases on prolonged use, and doctors have contemplated additional surgery to relieve symptoms. He feels that instability of his knee joint has been considered only under 38 C.F.R. Part 4, Diagnostic Code 5257 (1994). His right knee disability is a lifelong disability which will progress, and he has been issued a knee brace. His PTSD is worse than rated, including as reflected by his global assessments of functioning being as low as 35. Additionally, he has had four marriages, all ending in divorce, and he has had insomnia, nightmares, hallucinations, panic attacks, and he has become belligerent and had suicide attempts. The fact that he was hospitalized for PTSD for almost all of 1993 shows that he is unemployable. Consideration of the benefit of the doubt doctrine and the provisions of 38 C.F.R. §§ 4.1, 4.7, 4.10, 4.40, and 4.59 (1994), including in relation to right knee pain, is requested. 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 appellant's two-volume claims folder. 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 claim for service connection for drug abuse is not well grounded, that entitlement to an effective date earlier than May 29, 1989 for the grant of service connection for PTSD is not shown, and that the preponderance of the evidence is against increased ratings for PTSD and right knee Osgood-Schlatter's disease. FINDINGS OF FACT 1. The appellant has not submitted any competent evidence tending to show that his drug abuse was caused by his service-connected right knee or post-traumatic stress disorder disabilities, and the provisions of 38 U.S.C.A. § 1110 (West 1991) preclude service connection for primary drug abuse. 2. Manifestations of the appellant's service-connected PTSD include some anxiety and depression, but they do not produce or nearly approximate more than definite social and industrial impairment. 3. The Board denied service connection for an acquired psychiatric disorder claimed as PTSD in May 1983 on the basis that PTSD was not shown but a personality disorder was. A specific, prejudicial error of fact or law in that decision was not alleged, and an application to reopen the claim with new and material evidence was not received prior to May 29, 1989. 4. The appellant's service-connected right knee Osgood- Schlatter's disease disability produces right knee pain and disability which, overall, is no more than slight in degree. CONCLUSIONS OF LAW 1. An earlier effective date than May 29, 1989 for the grant of service connection for PTSD is not warranted. 38 U.S.C.A. §§ 5107, 5108, 5110, 7103, 7104 (West 1991); 38 C.F.R. § 3.400 (1994). 2. The appellant's claim for service connection for drug abuse is denied because it is not well grounded. 38 U.S.C.A. §§ 1110, 5107 (West 1991); Grottveit v. Derwinski, 5 Vet.App. 91, 93 (1993). 3. The criteria for a disability rating in excess of 30 percent for PTSD have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 4.1, 4.14, 4.130, Part 4, Diagnostic Code 9411 (1994). 4. The criteria for a disability rating in excess of 10 percent for right knee Osgood-Schlatter's disease have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 4.1, 4.40, 4.45, 4.59, 4.71, Part 4, Diagnostic Codes 5257 to 5262 (1994). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Drug abuse Before we discuss the merits of a claim, we must first determine whether it is well grounded; that is, whether it is plausible. Gilbert v. Derwinski, 1 Vet.App. 49, 55 (1991). We conclude that the appellant's claim for service connection for drug abuse is not well grounded, as it is not plausible. In order for a claim for service connection to be plausible, competent evidence must tend to establish a set of facts that would permit service connection. Here, the provisions of 38 U.S.C.A. § 1110 prohibit service connection for disability resulting from primary drug abuse. The appellant's claim in essence includes a claim for service connection of primary drug abuse. It is not legally possible for him to prove or establish this part of his claim. The only way the appellant's claim could be well grounded, is if he claimed (which he has) that a service-connected disability or disabilities caused it, and he submitted competent evidence in support thereof. The appellant, being a layperson, is incapable of establishing what caused his drug abuse in and/or after service, Espiritu v. Derwinski, 2 Vet.App. 492, 495 (1992), Grottveit v. Derwinski, 5 Vet.App. 91, 93 (1993), and no medical evidence has been submitted in support of the proposition that his substance abuse and dependence was caused by his service-connected disabilities. Only self-serving and unsupported lay statements and history supplied by the appellant and then recorded in his medical records tend to state that it was caused by either of the service-connected disabilities in question. No medical opinions are to this effect. Thus, as there is no competent evidence in support of the claim, it must be disposed of as not well grounded. Espiritu, 2 Vet.App. 495; Grottveit, 5 Vet.App. 93. The appellant will not be prejudiced by the Board's consideration of the claim as not well grounded, however, and he will be able to be able to submit any competent and pertinent evidence and to begin, "on a clean slate." Grottveit, 5 Vet.App. at 93. Earlier effective date The appellant seeks an earlier effective date than May 29, 1989, the date of his reopened claim for the grant of service connection for PTSD. His representative points out that there is a medical record dated July 26, 1982 which diagnosed PTSD, so the effective date of the grant of service connection should be October 1, 1981, the date of an earlier application for service connection, per 38 C.F.R. § 3.400(q). However, a final appellate decision of May 1993 would bar any such retroactive benefits and already adjudicated the evidence on file at that time. That entry was a clinical impression in a progress note of delayed stress disorder. The law on effective dates provides that when there has been a previous Board decision on a claim, that decision is final in the absence of clear and unmistakable prejudicial error of fact or law. 38 U.S.C.A. §§ 7104(a), 7103(c). The representative's notation of the July 26, 1982 medical record does not constitute an allegation of clear and unmistakable prejudicial error of fact or law in the Board's prior decision. The Board specifically considered such record -- which lists an impression, not a diagnosis, and of delayed stress syndrome, not PTSD -- in its May 1983 decision. At that time, despite the existence of that medical record, and after considering it, the Board did not believe that the evidence, overall, supported a diagnosis of PTSD. There were many other pieces of evidence which the Board considered which the Board felt tended to more strongly indicate that the appellant did not have PTSD. The Board was under an obligation to consider and weigh all of the evidence, and it found that it preponderated against the claim. There is no specific or written allegation of error in the Board's finding of the facts or conclusions with respect thereto under the laws as they existed at that time. Specifically, it has not been alleged that the Board did not consider and weigh the July 26, 1982 medical record. Accordingly, the Board's decision remains final. 38 U.S.C.A. § 7104. As such, the law on effective dates of awards as it applies to this case provides that in the case of a claim reopened after final adjudication, the effective date shall not be earlier than the date of receipt of application therefor, 38 U.S.C.A. § 5110(a), 38 C.F.R. § 3.400, or the date entitlement arose, whichever is later. 38 C.F.R. § 3.400, including 38 C.F.R. § 3.400(q)(1)(2). Applying the applicable law to the facts of the appellant's case, the Board again notes that the Board denied the appellant's claim in May 1983, and that the Board's decision is final. After the Board denied the appellant's claim, the appellant attempted to reopen the claim for service connection for PTSD in September 1986 by writing the RO a letter. In response thereto, the RO advised the appellant that in order to reopen the claim, he had to submit new and material evidence, and that since this information was not submitted with his September 1986 request to reopen the claim, no further action was being taken at that time. The appellant was advised to contact the RO if he had any questions. No response was received from the appellant. Then, on May 29, 1989, a letter was received from the appellant attempting to reopen the claim. In the letter, he stated that he was basing his claim on records of treatment from the VA Medical Centers in Lexington, Kentucky, on Cooper Drive, and at the Leestown Division and mental health clinic. Subsequently, records referred to by the appellant in this application to reopen the claim were obtained and incorporated into his claims folder, and the RO granted service connection for PTSD. Even now, PTSD is only one of the psychiatric disorders diagnosed in the veteran's case, sometimes by history only, and a severe personality disorder has also been reported. Entitlement did not arise with respect to the appellant's attempt to reopen the claim in September 1986, as the appellant did not submit the requisite new and material evidence as he had been advised. When a claim has been denied and the decision becomes final, new and material evidence must be received to reopen the claim. 38 U.S.C.A. §§ 5108, 7104(b); Manio v. Derwinski, 1 Vet.App. 140 (1991). 38 C.F.R. § 3.400(q)(1)(ii). Thus, entitlement could not have arisen prior to May 29, 1989, the date of the appellant's application to reopen the claim. Before this, new and material evidence had not been received. The effective date is to be the date of application to reopen the claim or the date entitlement arose, whichever is later. 38 U.S.C.A. § 5110(a), 38 C.F.R. § 3.400. The appellant applied to reopen the claim on May 29, 1989. As such, an earlier effective date than May 29, 1989 for the grant of service connection for PTSD would not be warranted. New and material evidence to reopen the claim for service connection of PTSD and showing entitlement thereto had not been received prior to this date. Increased ratings Regarding the appellant's other claims, we have determined that they are well grounded. Therefore, we must determine whether the VA has fulfilled its duty to assist him pursuant to 38 U.S.C.A. § 5107 (West 1991). We conclude that it has. It has assembled all relevant and necessary information for a fair and impartial disposition of them. Accordingly, we may discuss the claims on the merits. Gilbert, 1 Vet.App. 55. Right knee The evidence shows that the appellant has been treated or evaluated for right knee symptoms or complaints in and following service. The complaints and physical findings have included tenderness in the area of the right tibial tubercle. Surgery was scheduled for and then canceled in February 1970, after the appellant's condition had responded to rest. Limited activity profiles were issued in service. VA medical records from after service show some continued tenderness on occasions in the area of the right tibial tubercle. The appellant's right knee disability has been rated as 10 percent disabling since before the current claim period, which began with the April 1987 request for an increased rating. We are concerned with the current degree of impairment caused by the service-connected disability from that time until present. The history of the disability is important insofar as it bears on this issue and interpretation of recent examination reports. 38 U.S.C.A. § 1155; 38 C.F.R. §§ 4.1, 4.2. An October 1986 medical record from K. Sajadi, M.D. states that surgery was recommended, as the appellant had a loose bony fragment in the area of his right tibial tubercle. Physical examination was normal except for extreme tenderness in that area. On VA evaluation in November 1986, there was a full but painful range of motion of the right knee and some motion in the area of the tibial tubercle. In April 1987, it was decided not to operate on the right knee because the appellant had drank alcohol during hospitalization and because there was doubt as to whether the appellant would gain from surgery. In August 1989, the appellant had anterior tibial tubercle pain again, and X-ray revealed a nonunion of the right gastrocnemius insertion. He was admitted for surgery in September 1989, and underwent resection of a nonunion of the right tibial tuberosity. The appellant received a temporary total rating of 100 percent pursuant to the provisions of 38 C.F.R. § 4.30 (1994) in conjunction with this surgery. On hospital discharge, he was in good condition. The RO continued the 10 percent rating. In June 1990, the appellant stated that doctors were talking about right knee surgery again. VA medical records dating from 1990 to 1992 document right knee symptoms, history, complaints, and clinical findings. A June 1990 VA radiographic report indicates that there was a small density in the area of the right tibial tubercle, and that it appeared stable in appearance. A VA orthopedic clinic report of the same day indicates that resection of a remaining fragment of Osgood-Schlatter's disease may help the appellant. He had tenderness over his tibial tubercle clinically and had complained of pain on lifting from a bent-knee position. A VA examination was conducted in January 1991. X-rays revealed no appreciable arthropathy, and it was felt that his Osgood- Schlatter's disease was probably healed. The right knee joint space appeared normal, and there was no significant degenerative disease identified. At the time of the examination, the appellant complained that his knees were causing him problems. He reported that he limps from the right knee, and that prolonged standing hurts, and that he feels numbness and sharp pains in the anterior knee. He stated that he occasionally trips. He reported that he occasionally used Percodan for leg pain. Clinically, he leaned slightly to the left, and limped slightly on his right leg. He had a seven-centimeter surgical scar anteriorly on the right knee. He could stand on his toes and heels without pain, and was unable to squat due to difficulties with the right knee. Right knee range of motion was from zero to 140 degrees without pain. He had no muscle atrophy, contractures, or fasciculations. The right knee exhibited no effusion or abnormality, and the patella had a normal appearance. There was no pain on deep palpation. Muscular strength was 4/5 for the thigh and leg. He exhibited slight instability on standing on the right leg. The diagnoses were history of Osgood- Schlatter's disease of the right knee, and mild instability of the right knee with slight limping and a full range of motion. A VA radiographic report dated in February 1992 states that there were residual changes of the right knee secondary to Osgood- Schlatter's disease, and that the knee otherwise appeared unremarkable. A May 1992 VA medical record indicates that chondromalacia patellae was suspected, and that isometric quadriceps exercises were recommended. In July 1993, he complained of pain in both knees and bilateral crepitus and swelling. In September to October 1993, he complained of right knee pain on lateral movement, preventing exercise. An October to November 1993 VA domiciliary report and records associated with it indicate that the lower extremities had a normal range of motion without joint crepitus. An impression of chronic knee pain was reported. Disability ratings are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. 38 U.S.C.A. § 1155. Separate diagnostic codes identify the various disabilities. 38 C.F.R. Part 4. In order for the appellant to receive an increased rating, his right knee disability must produce or nearly approximate moderate knee impairment with recurrent subluxation or lateral instability; a dislocated semilunar cartilage (meniscus) with frequent episodes of locking, pain, and effusion into the joint; leg flexion limited to 30 degrees; leg extension limited to 20 degrees; or malunion of the tibia with moderate knee disability. 38 C.F.R. Part 4, § 4.7, Diagnostic Codes 5257, 5258, 5260, 5261, 5262. If it does not produce or more nearly approximate more than slight knee impairment with recurrent subluxation or lateral instability; a symptomatic meniscectomy disability; leg flexion limited to 45 degrees; leg extension limited to 15 degrees; or malunion of the tibia with slight knee disability, the 10 percent rating assigned may be sustained. 38 C.F.R. Part 4, § 4.7, Diagnostic Codes 5257, 5259, 5260, 5261, 5262. Nonunion of the tibia and fibula, with loose motion, requiring a brace, warrants a 40 percent evaluation. 38 C.F.R. Part 4, Diagnostic Code 5262. Preliminarily, the Board notes that the appellant had surgical correction for his tibial tubercle loose body and nonunion of the right gastrocnemius insertion, and that nonunion is not now present. Additionally, nonunion with loose motion requiring a brace is not present. This Diagnostic Code generally speaks to nonunion of the main weight-bearing shaft of the tibia and fibula anyway, rather than nonunion of a small fragment of the tubercle from Osgood-Schlatter's disease. It also speaks to loose motion of the knee joint, rather than of a muscle insertion to the bone/tubercle. This is clear from the plain legislative intent and a review of this criteria in light of other Diagnostic Code criteria and commensurate levels of disability. The veteran is not shown to have sufficient limitation of motion of leg flexion or extension to assign an increased rating under Diagnostic Code 5260 or 5261. Additionally, the appellant does not have malunion of his tibia, or a dislocated or removed meniscus. The question, then, principally is whether he more nearly approximates slight or moderate knee impairment. The Board notes in this regard that he limps no more than slightly and has no more than slight instability, has a nearly full range of motion of the right knee, and has normal or only slightly diminished muscle strength. Additionally, while the appellant has complained of swelling, neither swelling nor effusion into the joint has been documented clinically. The Board notes that disability of the musculoskeletal system is the inability to perform normal working movement with normal excursion, strength, speed, coordination, and endurance, and that weakness is as important as limitation of motion, and that a part which becomes disabled on use must be regarded as seriously disabled. However, a little-used part of the musculoskeletal system may be expected to show evidence of disuse, through atrophy, for example. 38 C.F.R. § 4.40. Here, the appellant has no atrophy and no or very little weakness. Additionally, he has no crepitus, and he limps no more than slightly. The provisions of 38 C.F.R. §§ 4.45 and 4.59 also contemplate inquiry into whether there is crepitation, limitation of motion, weakness, excess fatigability, incoordination, and impaired ability to execute skilled movements smoothly, and pain on movement, swelling, deformity, or atrophy of disuse. Instability of station, disturbance of locomotion, and interference with sitting, standing, and weight-bearing are also related considerations. The clinical evidence in this regard shows no more than slight disability, however, so under these provisions, and increased rating is not warranted. It is the intention of the rating schedule to recognize actually painful, unstable, or maligned joints, due to healed injury, as at least minimally compensable. 38 C.F.R. § 4.59. The appellant already receives a minimally compensable rating, however, and more than a slight knee disability is not shown. As such, per 38 C.F.R. § 4.7, an increased rating is not warranted. The fact that the appellant has been considered for additional surgery is not controlling or immensely probative. The additional surgery has not been performed, and the extent of disability and the functional limitations imposed as a result of the disability currently, rather than the fact that surgery has been contemplated, are what are important. 38 U.S.C.A. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.10, 4.40, 4.45, 4.59, 4.71, Diagnostic Codes 5257 to 5262. Despite the fact that a knee brace has been issued, no more than slight knee disability is shown. The appellant's service-connected right knee disability has been considered under applicable rating criteria. Additionally, it is to be rated based upon current impairment rather than the impairment which may become present in the future. 38 U.S.C.A. § 1155; 38 C.F.R. § 4.1. An exceptional disability picture with such related factors as marked interference with employment or frequent periods of hospitalization is not shown, so an extraschedular rating per 38 C.F.R. § 3.321(b)(1) is not warranted. The appellant indicated on his January 1991 VA examination report that he has worked as a mechanic from 1989 to 1991 earning $500 a month, and that he had lost only 10 days from work in the past 12 months, and that it was due to a knee operation. He received a temporary total rating in relationship to the surgery. The rating schedule is adequate for the appellant's disability picture. PTSD Regarding the appellant's claim for an increased rating for PTSD, the Board notes that the provisions of 38 U.S.C.A. § 1155 and 38 C.F.R. §§ 4.1 and 4.2, mentioned above, also apply here. The evidence must show that the appellant has or more nearly approximates considerable rather than definite social and industrial impairment due to his service-connected PTSD in order for an increased rating to be assigned therefor. 38 C.F.R. Part 4, Diagnostic Code 9411. The severity of psychiatric disability is based upon actual symptomatology, as it affects social and industrial adaptability. Two of the most important determinants of disability are time lost from gainful work and decrease in work efficiency. The Board must not underevaluate the emotionally sick veteran with a good work record or overevaluate his condition on the basis of a poor work record not supported by the psychiatric disability picture. For this reason the examiner's objective findings and analysis of the symptomatology are the essentials. The examiner's classification of the disease as mild, moderate, or severe is not determinative; rather, the report and the analysis of the symptoms and history are. 38 C.F.R. § 4.130. In Hood v. Brown, 4 Vet.App. 301 (1993), the Court of Veterans Appeals stated that the term "definite" in 38 C.F.R. § 4.132 was "qualitative" in character, whereas the other terms were "quantitative" in character, and invited the Board to "construe" the term "definite" in a manner that would quantify the degree of impairment for purposes of meeting the statutory requirement that the Board articulate "reasons and bases" for its decisions. 38 U.S.C.A. § 7104(d)(1) (West 1991). In a precedent opinion, dated November 9, 1993, the General Counsel of the VA concluded that "definite" is to be construed as "distinct, unambiguous, and moderately large in degree." It represents a degree of social and industrial inadaptability that is "more than moderate but less than rather large." O.G.C. Prec. 9-93 (Nov. 9, 1993). The Board is bound by this interpretation of the term "definite." 38 U.S.C.A. § 7104(c). With these considerations in mind, the Board will address the merits of the claim at issue. Here, the evidence shows that in addition to PTSD, the appellant has also been diagnosed with or felt to have a personality disorder, a dysthymic disorder, continuing alcohol abuse and dependence, and substance abuse by history. He has received extensive treatment for and is significantly disabled by alcohol and drug abuse. His personality disorder which was described as severe in January 1993 and chronic alcohol abuse and dependence and substance abuse and major depression or dysthymic disorder, however, have not been service-connected, and the use of manifestations not resulting from service-connected disease or injury in establishing the service-connected evaluation is prohibited. 38 C.F.R. § 4.14. Thus, while he has claimed that his service-connected PTSD has required hospitalization and so forth and the evidence shows that alcohol and/or drug abuse and dysthymic disorder, major depression, or depression that have not been related to PTSD instead were often what required hospitalization, the PTSD rating may not be increased thereby. As to the history of the appellant's PTSD, the evidence shows that it was, to some extent, suspected to be present in the 1980's, but it was not reported nearly as much as other psychopathology, which was treated or diagnosed. Other psychopathology currently, similarly, is suspected or diagnosed and treated more frequently than PTSD. Primarily, we are concerned with the history as it relates to present disability and examination reports. 38 C.F.R. §§ 4.1 and 4.2. The rating to be assigned is to be based upon impairment shown over the rating period in question, which is from May 1989 to present. Evidence indicates that the appellant has been treated in the VA mental hygiene clinic, where his various psychiatric problems have been discussed and treatments and plans for solutions to them have been formulated and attempted. In March 1990, the appellant complained of nightmares of Vietnam, but alcohol abuse and a personality disorder were diagnosed. Continuous alcohol dependence and possible PTSD were assessed in July 1990. In September 1990, he reported attempting to cope with his feelings of failure by working 70 to 80 hours per week between a brace shop and a service station. He reported sleeping five to six hours per night and eating poorly, losing weight. An October 1990 report of contact indicates that it was suspected that the appellant had called the RO and threatened two VA psychiatrists. The report of contact, signed by the chief of psychiatry, indicates that the appellant had denied making such threats but agreed to be seen. In November 1990, the appellant reported wanting to kill himself for the past six weeks. He had taken too much medicine six weeks ago after a breakup with his girlfriend. He had been driving around figuring out if he wanted to live or not. He cried during his interview and seemed depressed. The impression was depression. As of December 1990, his PTSD diagnosis remained provisional, and the assessment was major depression. A VA psychological assessment report dated in January 1991 indicates that his testing was consistent with an antisocial personality disorder, and no diagnosis on Axis I. The appellant had described to the psychologist prior to the assessment problems such as periods of wanting to kill himself, losing his temper and threatening others, bouts of drinking followed by voluntary hospital admissions, being estranged from his family, disliking policemen, and having legal and marital problems and addictions. Another VA medical record dated in January 1991 states that the appellant continued to work part time in the brace shop. Others dated in January 1991 state that he was started on Prozac. A VA psychiatric examination was conducted in May 1991. The appellant reported that during his Vietnam service, he did not really have any real risk and did not participate in combat. His closest threat to life was being near an army dump explosion, and making trips to Cambodia, to pick up signal equipment. After returning to the states, he began working for the parks department, and then later for an automobile dealer, then in truck parts, then for two years with a brace (prosthetics) shop. He had worked for eight years for a government, going from laborer to equipment operator to mechanic. He had been married and divorced four times, and his divorces were related to alcohol abuse or the fact that his wives were afraid of him. His last wife had had an affair, and he could not tolerate that. He had been frequently violent. He described a positive startle, and reported being somewhat hypervigilant and suffering from insomnia and irritability to the point of violence at times. Clinically, he appeared to be somewhat restless, admitted to being dysphoric, and stated that there were times when he had suicidal ideations, but no major intentions in several months. His speech was normal, and there was no psychotic thinking or formal thought disturbance. Cognitively, he was intact and considered competent. The diagnoses were dysthymic disorder, episodic alcohol dependence, mixed substance abuse in remission, and a mixed personality disorder with passive aggressive, antisocial, and dependent hostile traits. His global assessment of functioning was fair. It was suggested that he continue with medication (antidepressants) and individual therapy for his psychiatric difficulties. He had several features of PTSD but his personality disorder was considered as the most problematic feature of his psychiatric history. An April 1992 psychological evaluation report from Merle Yalowitz, M.Ed. and Thomas E. Schacht, PsyD states that clinically, the appellant's speech was normal but almost pressured. His affect was blunted. At times he almost wept. The appellant and the psychologist established a positive relationship, because the appellant saw him as a sympathetic listener. The psychologist reported a history of manipulative behavior by the appellant. For instance, the appellant had advised the psychologist that while at the VA, the appellant had wanted to see a VA neurologist for numb arms and legs, but was denied one, so he asked for an agent orange physical so he could see the neurologist. Additionally, the appellant reported trying to work his way around the system. Furthermore, the appellant reported that he had alarmed health care practitioners at the VA by grabbing them, and "this really scares 'em." He also admitted that several years ago, he had threatened the life of one particular doctor. He was oriented to person, place, time, and circumstances, and he was alert. His memory was intact. His speech was tangential. There were no indications that he was not in contact with reality or that he was having loose associations. He was clearly preoccupied with the opportunity for secondary gain. It was difficult to form a clinical impression with any degree of confidence, due to the possibility of exaggeration of symptoms. The diagnoses were substance abuse in remission; PTSD, by history; and a personality disorder with passive-aggressive features, by history. It was stated that at the present time the appellant would not be expected to be able to demonstrate much tolerance or interpersonal resilience in a work-related setting. His alcohol dependence was considered a problem in his receiving benefits directly as the payee. A VA hospital discharge summary dated in November 1992 indicates that the appellant, on admission, reported increased agitation with living with a friend. He had become more depressed and suicidal. On mini mental status examination, he was very calm and had appropriate affect for the conversation. On admission to an open ward, he was extremely agitated but had no suicidal ideation but had a marked degree of depression. After medication, his sleeping reportedly improved, and he was without any nightmares. The diagnosis was chronic PTSD, mild to moderate, with moderate depression. The global assessment of functioning at the time of admission had been 40. A VA hospital discharge summary for a period during December 1992 states that after his previous discharge, he had become very anxious on returning to his new apartment. He was trying to decide whether to commit suicide or be readmitted. During hospitalization, he responded to milieu therapy and was cooperative. It was reported that he had many unresolved situations in his life, particularly his Vietnam experiences and family problems. He had extremes of guilt about many of the events which had occurred in his life. The diagnoses were dysthymia, symptoms of PTSD, chronic alcohol dependence and abuse in remission, and borderline personality disorder. His global assessment of functioning at the time of admission was 35. A December 1992 to January 1993 VA hospitalization resulted in an irregular discharge after the appellant was found to be acutely intoxicated in a bathroom. After being discovered, he became very belligerent, hostile, and angry, and threatened a physician on duty. The diagnoses were chronic alcohol dependency and abuse, major depression, questionable PTSD, and a borderline personality disorder. He was again hospitalized in a VA facility in January 1993, reporting that his mix of (apparently prescribed) drugs had been making him have bad dreams and nightmares, and that as a result, his roommates were afraid of him. Clinically, he was disheveled, and had fair eye contact and pressured speech. His mood was depressed and his affect was restricted. He was oriented to place, situation, and person, but not to specific date. His thoughts were vague for suicidal ideation and negative for homicidal ideation, auditory and visual hallucinations, looseness of associations, and flight of ideas. His judgment and insight were poor. It was reported that he had been admitted due to drinking and increased nightmares, sleep problems, anxiety, and agitation. He seemingly took no responsibility for his drinking, the physician reported. Medication was prescribed. He continued to deny an alcohol problem. The diagnoses were major depression, PTSD by history, alcohol dependency, and a borderline personality disorder. The global assessment of functioning was 30 on admission and 50 in the last year. A January 1993 VA hospital discharge summary indicates that the appellant reported a history of alcohol abuse but none for two weeks. He reported that he had been in the area to contact his only daughter, whom he had not seen in many years, but that his ex-wife would not allow him to do so. During hospitalization, his condition improved and he did well without pharmacotherapeutic intervention. The diagnoses were adjustment disorder and severe personality disorder with antisocial, borderline, and narcissistic traits. A March 1993 VA hospital discharge summary indicates that he was admitted to obtain 30 days of sobriety so that he could enter a PTSD treatment program. He reported that his symptoms of post- traumatic stress included intermittent episodes of aggressive behavior with uncontrollable rage, intrusive thoughts, nightmares of Vietnam, combat experiences, and guilt feelings. The discharge diagnoses were alcohol dependence, past history of opiate and cannabis abuse, PTSD by history, antisocial, borderline, and narcissistic traits, and probable mixed personality disorder. The appellant was hospitalized in a VA facility in May 1993. He reported that he had been diagnosed with PTSD in 1980 and had had some form of treatment for it since then. He reported that his symptoms included depression, intrusive thoughts, recurrent distressing nightmares, flashbacks, avoidance of feelings, avoidance of situations that remind him of his experience in combat, feelings of detachment, isolation, difficulty sleeping, irritability with outbursts of anger, hypervigilence, and an exaggerated startle response. He reported that all of these symptoms started shortly after returning from Vietnam. The diagnoses were PTSD, and alcohol dependence in remission and essential tremor. In July 1993, VA psychological testing was conducted on the appellant to assess his personality functioning. The test results strongly suggested that the results of one test were invalid. The appellant was resistive to taking a different test. The pattern possibly indicated symptom exaggeration, confusion, fear of the testing situation, faking psychological problems, or severe psychopathology. A May to August 1993 VA hospital discharge summary indicates diagnoses of PTSD, dependent personality disorder, and polysubstance abuse, in remission. A VA psychiatric examination was conducted in September 1993. He last reportedly worked in November 1991, making orthopedic heels. He was living off of Social Security and his service-connected disability check. Clinically, he was moderately depressed. His affect was congruent with his mood and appropriate for the situation. He was oriented to time, place, person, and situation. He described dissociative symptoms which could be compatible with PTSD. He had symptoms consistent with PTSD of a moderate degree, a history of alcohol dependence and narcotic drug abuse and a borderline personality disorder. Corresponding diagnoses were reported. During hospitalization, there were reported moderate PTSD, a borderline personality disorder, a history of alcohol dependence and major depression with global assessment of functioning of 72. The appellant was admitted to a VA hospital in June 1994. He had gone to stay with his family, but he could not get along well with them. He stated that his family was mean to him. He had had four beers on the day of admission. He denied auditory or visual hallucinations. The diagnoses were PTSD by history, depression, and chronic alcohol abuse and dependency. There were moderate psychosocial stressors secondary to chronic alcohol abuse and poor mental health. The global assessment of functioning was 35 on admission and 60 on discharge. Weighing the evidence, the Board concludes that the appellant's service-connected PTSD does not approximate more than definite social and industrial impairment. It has been classified as between mild and moderate by examiners who have evaluated the appellant's PTSD in light of its symptomatology, per 38 C.F.R. § 4.130. This does not approximate more than the General Counsel definition of "definite" social and industrial impairment delineated in the wake of Hood and described above. Moreover, PTSD has not been his predominant psychiatric problem. It has been said that he has a severe personality disorder, which has been repeatedly diagnosed. Many of the symptoms which the appellant attributes to PTSD have been attributed to his personality disorder and alcohol abuse by health care providers. Their opinions are probative, whereas his assertions are not. Espiritu, 2 Vet.App. 495; Grottveit, 5 Vet.App. 93. It is apparent, moreover, that primary alcohol abuse has caused a great degree of his psychiatric impairment and problems interacting with others. Neither the alcohol abuse nor the personality disorders has been service-connected, and no evidence indicates that they are symptoms of PTSD. The appellant has a good work record with several different jobs, and missed only ten days in over a year, and this was due to his knee surgery. The appellant has told various stories to various examiners, and they are self-serving and unsupported by corroborating competent evidence. His own version of his history as to what his symptoms of PTSD are is not competent evidence as to his PTSD. Espiritu v. Derwinski, 2 Vet.App. 492, 495 (1992); Grottveit v. Derwinski, 5 Vet.App. 91, 93 (1993). This is especially true when medical examiners have attributed many of his psychiatric symptoms to his personality disorder and chronic alcohol abuse instead. He is not shown to be more than moderately disabled by his PTSD, according to the medical evidence. Its diagnosis has been omitted on several periods of psychiatric treatment he has received. No more than definite impairment from PTSD is shown. Accordingly, per 38 C.F.R. § 4.7, an increased rating is not warranted. In response to the contention pointing out the appellant's global assessments of functioning, the Board again notes the provisions of 38 C.F.R. § 4.14 and that the appellant has psychiatric problems other than PTSD which appear to be accounting for much more psychiatric impairment than it. Additionally, while he may have received hospital treatment during much of 1993, no more than definite social and industrial impairment from PTSD is present, and he received a temporary total rating pursuant to the provisions of 38 C.F.R. § 4.29 in conjunction with hospitalization in 1993. In response to the contention that his PTSD is 70 or 100 percent disabling, if he does not have more than definite social and industrial impairment from it, it follows that a schedular disability rating in excess of 30 percent is not warranted. Additionally, the service-connected PTSD disability 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)(1). PTSD has not required frequent periods of hospitalization, and prior to alcohol treatment, the appellant had a good work attendance record. The special 1993 PTSD treatment appears to have been a one-time process. Additionally, the rating schedule provided a 100 percent temporary total evaluation while he was hospitalized for PTSD. Accordingly, an extraschedular rating to increase the rating above 30 percent is not warranted. Benefit of the doubt doctrine Application of the benefit of the doubt doctrine has been considered with respect to all material issues. However, an approximate balance of positive and negative evidence on material issues is not present, so the doctrine is not for application. Gilbert, 1 Vet.App. 53. ORDER Service connection for drug abuse is denied as not well grounded. An earlier effective date than May 29, 1989 for the grant of service connection for post-traumatic stress disorder is denied, as are increased ratings for PTSD and right knee Osgood- Schlatter's disease. SAMUEL W. WARNER 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. 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.