Citation Nr: 0007736 Decision Date: 03/22/00 Archive Date: 03/28/00 DOCKET NO. 98-05 211A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Louis, Missouri THE ISSUE Entitlement to a rating in excess of 50 percent for service- connected post-traumatic stress disorder (PTSD), the initial rating assigned, effective from August 6, 1996. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States WITNESS AT HEARINGS ON APPEAL Appellant ATTORNEY FOR THE BOARD William D. Teveri, Associate Counsel INTRODUCTION The veteran served on active duty from April 1968 to November 1968. This appeal arises from a July 1997 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Louis, Missouri. The July 1997 rating decision on appeal granted the veteran's request for service connection for PTSD, assigning a 30 percent rating and an August 6, 1996 effective date. In February 1998, during the pendency of this appeal, the RO increased the rating to 50 percent disabling. Inasmuch as the grant of a 50 percent rating is not the maximum benefit for PTSD under the rating schedule, and as the veteran has not expressly indicated that she wishes to limit her appeal to that particular rating, the claim for an increased rating for that disability remains in controversy, and hence, is a viable issue for appellate consideration by the Board. See AB v. Brown, 6 Vet. App. 35, 38-39 (1993). FINDING OF FACT The veteran's service-connected PTSD was not manifested by more than considerable social and industrial impairment, or more than occupational and social impairment with reduced reliability and productivity, from August 6, 1996 to November 3, 1997; but her PTSD has been manifested by severe social impairment, and it has precluded employment, since November 4, 1997. CONCLUSION OF LAW The criteria for a rating in excess of 50 percent for PTSD, from August 6, 1996, to November 3, 1997, have not been met, but the criteria for a 100 percent rating for PTSD, from November 4, 1997, have been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 4.1-4.14, 4.16, 4.132, Diagnostic Code 9411 (1996); 38 C.F.R. §§ 4.1-4.14, 4.130, Diagnostic Code 9411 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSION Initially, the Board finds the veteran's claim well grounded within the meaning of 38 U.S.C.A. § 5107(a). The United States Court of Appeals for Veterans Claims (Court) has held that when a claimant is awarded service connection for a disability and subsequently appeals the RO's initial assignment of a rating for that disability, the claim continues to be well grounded as long as the rating schedule provides for a higher rating and the claim remains open. See Shipwash v. Brown, 8 Vet. App. 218, 224 (1995). The Board is also satisfied that all relevant facts have been properly developed and that 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). Additionally, in accordance with 38 C.F.R. §§ 4.1-4.2 and Schafrath v. Derwinski, 1 Vet. App. 589 (1991), the Board has reviewed the veteran's service medical records and all other evidence of record pertaining to the history of the veteran's service-connected disability. The Board has found nothing in the historical record which would lead to a conclusion that the current evidence on file is inadequate for proper rating purposes. Disability evaluations are determined by the application of VA's Schedule for Rating Disabilities which is based on the average impairment of earning capacity resulting from such diseases and injuries and their residual conditions in civil occupations. Separate diagnostic codes identify the various disabilities. 38 U.S.C.A. § 1155; 38 C.F.R. §§ 3.321(b)(1), 4.1; Fenderson v. West, 12 Vet. App. 119, 125 (1999). The basis of disability evaluations is the ability of the body as a whole, or of a system or organ of the body to function under the ordinary conditions of daily life, including employment. See 38 C.F.R. § 4.10. The Court has held that at the time of an initial rating in an original claim separate ratings can be assigned for separate periods of time based on facts found, a practice known as "staged" ratings. See Fenderson, at 126. The Board notes the initial 30 percent rating for the veteran's service-connected PTSD is effective August 6, 1996, the date of receipt of the veteran's application for compensation, and that the 50 percent rating assigned in February 1998 is also effective August 6, 1996. Thus, the Board will consider whether ratings higher than 50 percent are warranted subsequent to August 6, 1996. In August 1996 the veteran requested service connection essentially for the residuals of traumatic events she reported had happened to her during her Air Force active duty service. These events included alleged harassment by a drill instructor and being "ostracized" by her comrades during basic training; being sexually harassed by lesbian Air Force personnel; being sexually harassed by male Air Force personnel at her first permanent duty station; and being raped and made pregnant by a male Air Force non-commissioned officer. Her service medical records contain no evidence of any complaints of, or treatment for, any psychiatric disorder. Her October 1968 separation physical examination report indicates that, upon clinical evaluation, she was found to be normal psychiatrically. There has been no medical evidence submitted of any complaints of, or treatment for, any psychiatric disability, prior to November 1989. A November 1996 statement from a private Ph.D. clinical consultant indicates the veteran was treated from November 1989 through January 1991 for a dysthymic disorder. During a November 1996 VA psychiatric examination the veteran reported being divorced but living with a roommate and working as an accountant for the Department of Defense. The veteran reported a strict Catholic upbringing, going to a Catholic college, and being 18 years old and a virgin when she entered the Air Force in April 1968. She essentially reported the events she had described in the statement attached to her initial application for service connection. Further, she reported that subsequent to the rape she told the man, a sergeant, that they had to get married, and that they were married two weeks later. She reported she had to resign from the Air Force due to her pregnancy. She reported she became pregnant again even though she was on birth control pills, and wanted an abortion, but her husband refused, and the baby was born. Being depressed after this birth, she received "some" counseling, and was told she was suffering from postpartum depression. She reported she refused hospitalization. She then reported that she "got better," and went back to college, that her husband went to Germany with a "girlfriend," and the veteran moved in with her parents in Kansas City. She reported the marriage deteriorated, she was divorced in 1975, and she retained custody of the children. She reported that she sought counseling in 1983 for depression, alcohol abuse, and rage reactions, and was in counseling "on and off" for a number of years, including group therapy, Alcoholics' Anonymous, and groups for children of alcoholics. She remarried in 1988, and this marriage lasted four years, with no children. She completed college and became a Certified Public Accountant (CPA), and reached a high position with Sprint, making $60,000 per year. She reported her depression worsened, however, and she began missing work, causing her to be fired. She reported then going through a succession of jobs, totaling twelve (12), eight of which resulting in being fired. In March 1996 she was employed by the Department of Defense as an accountant, entering as a GS-5. She reported that, at the present time, her activities were very limited, i.e., going to the Vet Center, where she was referred to the PTSD clinic and told to apply for service connection for PTSD, related to her inservice rape. She reported being on no medication, that her general state of health was good, but that she had no social contacts, and no contact with her children, who are now grown and living apart from the veteran. She also reported no contact with her parents. She reported symptoms of depression, including poor sleep, increased weight, crying spells, feeling self- conscious and uncomfortable around people, having trouble concentrating, and making a lot of mistakes in her work. Upon mental status examination the veteran presented as being well-developed, well-groomed, neatly dressed, and looking depressed. She was noted to be alert, cooperative, responding to questions in a relevant, logical, and goal- directed manner. The examiner indicated the veteran admitted depression, with the major signs and symptoms meeting the criteria of the American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). She denied suicidal or homicidal ideations. Her intelligence was estimated to be above average, as judged by her education, fund of knowledge, and vocabulary. She was oriented to time, place, and person. Her memory for recent and remote events was noted to be intact, as was her judgment. She was noted to have a good deal of insight and was motivated to remain in treatment. The diagnoses were: (Axis I) dysthymic disorder with time of onset while still in the military, and related to the stress of rape and ensuing poor capacity to adjust to the experience; (Axis II) none; (Axis III) none; (Axis IV) stressor - severe in the form of rape while in service; (Axis V) Global Assessment of Functioning (GAF) 50, indicating impairment in social, emotional, and occupational functioning. The prognosis was guarded because of a tendency towards relapse and evidence of recent deterioration in productivity, as well as in initiative and efficiency. The examiner indicated the veteran was still able to work, but at a much lower level. The incapacity from her disability was noted to be mild to moderate. A December 1996 statement from an R.N., M.S. Ed., at the Vet Center, indicated the veteran had been seeking assessment and treatment for difficulties she had been experiencing for the previous twenty-five years, including sexual trauma and PTSD. This health care professional indicated that, as a result of the assessment, she believed the veteran experienced PTSD, in that the symptomatology met each criteria required to receive the diagnosis, with a rape and prolonged sexual harassment while she was enlisted in the military being the identifying trauma. The health care professional indicated that she also believed, after discussing the historical course of the veteran's symptomatology, that this disorder has become a chronic pattern of behavior leading to long-term difficulties, including problems with work and relationships. The professional also indicated the veteran struggled with issues related to self worth, safety, intimacy, competency, etc. She concluded that she believed the trauma the veteran experienced while in the military directly led to the development of past and current difficulties. A December 1996 statement from a private Ph.D., indicated the veteran was seen for group psychotherapy from January 1979 to March 1979. He noted her diagnosis was dysthymic disorder, with depression and anxiety being the chief symptoms. She was also struggling with a difficult marriage at that time, and was referred to the group for sexual abuse survivors by her primary therapist due to childhood sexual abuse issues. The Ph.D. noted that the veteran left the group "quite abruptly and prematurely," stating that she could not handle the intensity of the feelings she was experiencing. VA treatment reports from November 1996 through February 1997 were reviewed. They indicate that, while the veteran appeared to be less depressed, less hopeless, had better concentration, and better sleep habits, she had low self esteem and was prescribed Paxil, Trazodone, and Robaxin (a muscle relaxer). A November 1996 report contains an impression of major depression, recurrent; rule out bipolar disorder, possible PTSD; history of alcohol abuse, in remission. She was started on Paxil, with a gradual increase in dosage. A diagnosis indicated major depression, recurrent, without psychosis. Another November 1996 report noted that, when reporting events at her first duty station, the veteran's demeanor shifted between what appeared to be two different affective states. At times, she was tearful and anxious; at other times, she displayed a slight smile and appeared disengaged or dissociated. When "staff" fed back these observations, the veteran stated that she sometimes felt like two different people or two personalities; one was weak, feminine, emotional, and irrational; the other was strong, masculine, logical, rational, and unafraid. Treating considerations and recommendations noted that the veteran presented with multiple symptoms and problems of living. She appeared to have difficulty managing her impulses and affective reactions. She had difficulty being alone, and appeared to try to avoid the internal turmoil and emptiness by anesthetizing herself with drugs, alcohol, and chaotic relationships. Her tendency to undermine her progress and achievements suggested that she would have difficulty allowing herself to succeed in any treatment she undertook at that time. Based on her report of trauma experienced in the military, her abusive, chaotic childhood history, and her history since military discharge, the diagnostic impression were: (1) rule out PTSD, military-related, chronic, severe; (2) rule out dysthymia, related to childhood experiences; (3) alcohol/drug abuse, in remission by veteran's report; and (4) rule out borderline personality disorder. In an April 1997 private physician psychiatric examination report, the veteran reported that she had many absences during her employment as a clerk for the Department of Defense, is doing work well below her academic training and past level of functioning, has experienced her work environment as reminiscent of previous hostile duty stations, and has taken hours without pay due to ongoing insomnia, anxiety, and emotional distress. She reported having very few close friendships and is no longer close to her children or parents and siblings. The physician indicated the veteran's current symptoms were intrusive, distressing recollections of brief but intensely negative Air Force experiences, frequent nightmares, feelings of estrangement, restricted range of affect, difficulty concentrating, exaggerated startle response, and persistent and intense psychological distress on exposure to any event which resembles an aspect of her traumatic experiences. The physician indicated the veteran reported trying to avoid associated stimuli, especially crowds, as this causes an increase of anxiety, suspicion, and an urge to withdraw, avoiding most social situations (except for a male roommate), and tries to work alone. She reported that even with a friend or family member, closeness and touch prompts her to abruptly push them away from her. She denied being sexually active in recent months, claimed a past pattern of extreme irritability and temper outbursts, and of substance abuse. She reported still experiencing insomnia, even while on medication. The physician then stated a finding that parrots the criteria for a 50 percent rating under the former 38 C.F.R. § 4.132, Diagnostic Code 9411 (1996). He also indicated that her failure to achieve and maintain expected levels of function have, in turn, precipitated and exacerbated both dysthymic and major depressive disorders for which she has been and is being treated by the Kansas City VA Medical Center. During the veteran's April 1997 personal hearing she essentially reported the stressors she contends caused her PTSD, and indicated she was being treated at the Kansas City Medical Center and the Vet Center. She also testified that she had residuals of a back injury. i.e., chronic back pain, that doctors had told her was due to her stressors; that she was receiving Workmen's Compensation for her back injury; that she was also seeing a private psychiatrist for her mental problems; that she did not report the inservice rape to anyone, or tell anyone about it; and that the therapists she saw after her discharge are no longer in practice and she could not obtain their records. An April 1997 list of medications submitted by the veteran included Paroxetine HCL, 40 milligrams, one tablet every morning; Trazodone HCL, 50 milligrams, one tablet at bedtime; Methocarbamol, 750 milligrams, one tablet three times a day; and Ibuprofen, 400 milligrams, one table three times a day. In a December 1997 report in consideration of VA Chapter 31 Vocational Rehabilitation, the veteran indicated that, in addition to her PTSD disability, she had also injured her back at work and has residual pain that impairs her ability to work. She also reported she was being prescribed Amitriptyline and Librium for her PTSD, and pain killers for her back pain. She reported that her activities were highly limited, that she was depressed, and that she rarely leaves her house, as it was difficult to even be around people to shop for groceries. She sometimes visits with her brother, who has Down syndrome, at his group home, sometimes with her father. She reported she occasionally went to the library to read, but refrains from speaking with anyone there. She reported having no friends or activities, having severe nightmares, flashbacks, dissociative episodes, concentration problems, and panic attacks when around people. Although the veteran tested in the high average as to her abilities, she did not think she was capable of holding down even part-time employment at that time. The Vocational Rehabilitation counseling psychologist who interviewed the veteran indicated that, with her various symptoms and difficulties, it was a concern that the veteran was not stable at that point, that her industrial capacity seemed to be severely affected, that she was in an acute stage of her PTSD, and that it appeared to grossly affect her social and industrial ability to adapt. The counselor indicated it was not believed that the veteran was able to demonstrate behaviors at that time which would enable her to obtain or to retain employment. The counselor indicated that the veteran's ability to maintain effective or favorable relationships with other people was "almost totally gone." The conclusion of the counselor was that the veteran had "a serious employment handicap," that it was believed that a "vocational goal [was] not a feasible prospect for her at the present time", and that it was also believed that the veteran could not even be able to participate in any independent living services. The counselor indicated that "[a]t the present time, she seems to function best by staying home and isolating to a large extent." The counselor also indicated the veteran was not believed to have "overcome the effects of her service connected [PTSD] by her having a CPA license, or a Bachelor's Degree." During a January 1998 VA psychiatric examination the veteran reported her previous marital, treatment, and employment history, as noted above. She reported she had not worked since 1992. Upon mental status examination the veteran was noted to be clean hygienically, oriented to time, place, and person, and had a flat affect. She was noted to seemingly be somewhat ill at ease, her judgment and insight were noted to be fair, while her peer relationships were noted to be poor. She reported no close friendships, and felt that people tended to intimidate her, while feeling that her temper was average. She reported middle sleep disturbances and frequent nightmares about being raped, with these nightmare occurring several times a month. She reported her memory was "slipping," and her concentration was poor. She complained of fatigue, low energy, being depressed but seldom crying, having suicidal thoughts in a fleeting fashion but no ideations, having variable moods, but no hallucinations or delusions, and being paranoid around people. She reported she did not like to go out and had quit driving, only going to the library or shopping, had no close personal or family relationships, and worries about the future. She reported feeling guilty about the rape and angry about not reporting it sooner and handling it better. She reported she spends her day trying to read, has no hobbies, and no social life. The examiner indicated the veteran was capable of handling VA funds. The diagnoses were: (Axis I) PTSD with depression, history of alcohol and polysubstance abuse, now in remission; (Axis II) deferred; (Axis III) none; (Axis IV) stressors were her focus on her rape and many abusive relationships with men following that incident; (Axis V) GAF of 50 - her affect was quite flat and she appeared quite depressed. The prognosis was noted to be guarded, and the incapacity was noted to be marked. The examiner indicated that, at this time, the veteran could not tolerate ordinary stress to persist at simple jobs on a regular basis. She also submitted an employment history report indicating twelve jobs since February 1987, the last ending in June 1997. During her April 1998 personal hearing she testified as to her work history and her inability to keep employment; that she had been refused Vocational Rehabilitation due to her PTSD; that, although she has a driver's license, she does not drive; that she swims three times per week with her father at the YMCA; that she works with a social worker at independent living; is very forgetful about things like leaving a pan on the stove when leaving the house; that she does not like being around people; that she sees a private psychiatrist once a month to monitor her medication; that she sees a counselor at VA every two weeks; that she takes the prescriptions noted above; that she visits her impaired brother at his group home; that she has nightmares of her rape; that she is going through foreclosure on her home; that she lives by herself; that she has chronic muscle pains attributed to stress from her PTSD by a physician; that she has never been hospitalized for PTSD; that she cannot concentrate; that she was a CPA; that her sole income is her VA disability; and that she was denied Social Security Disability benefits. A June 1998 statement from her son indicates that the veteran deteriorated from a good paying job as a CPA to having to sell most of her possessions and going through foreclosure on her home, and possibly becoming homeless, after her "breakdown." He indicated the refusal of VA Vocational Rehabilitation was the "final nail in the coffin" in regard to the veteran's being able to support herself. He confirmed the veteran had almost no contact with her children, family or friends, that she seldom left the house, and rarely allowed anyone near her. He indicated that the veteran lived "in a reality that isn't consistent with anyone else's," and even confused her sons with their father, to the point of calling the police. He indicated he did not even fully believe the veteran's statements that her father drove her to her appointments or elsewhere, as he was eighty-four years old and "can barely see." He indicated that after she had been stopped several times by police for stopping at green lights, driving way under the speed limit, and being accused of drinking because she was weaving on the road, she stopped driving. He indicated that she now "walks to the store and library like a pathetic bag lady." He also reported that the veteran's "thought process is messed up," that she "mingles her ideas of who is against her and who is for her," and that she "is terrified to leave the house and gets sick anytime one of us has to take her somewhere." He indicated the veteran denied the severity of her condition, "gets physically sick around men," panics, then digresses, makes no sense, talks irrationally, then "just goes numb." Service connection for PTSD was granted by the July 1997 RO decision on appeal. A 30 percent rating, effective August 6, 1996, the date of receipt of the veteran's application for service connection, was assigned. A February 1998 rating decision increased the rating to 50 percent, effective August 6, 1996. During the pendency of this appeal the schedular criteria for evaluating PTSD were changed, effective from November 7, 1997. Where the law or regulations change while a case is pending, the version most favorable to the claimant applies, absent congressional intent to the contrary. Karnas v. Derwinski, 1 Vet. App. 308, 312-313 (1991). To give the veteran every consideration with respect to the current appeal, the claim will be evaluated under the former criteria until November 7, 1997, and under both the former and the revised rating criteria subsequent to that date. In Rhodan v. West, 12 Vet. App. 55 (1998), the Court observed that when the Secretary adopted the revised mental disorder rating schedule and published it in the Federal Register, the publication clearly stated an effective date of November 7, 1996. The Court added, because the revised regulations expressly stated an effective date and contained no provision for retroactive applicability, it is evident that the Secretary intended to apply those regulations only as of the effective date. Therefore, in view of the effective date rule contained in 38 U.S.C. 5110(g), which prevents the application of a later, liberalizing law to a claim prior to the effective date of the liberalizing law, the Secretary's legal obligation to apply November 7, 1996, as the effective date of the revised regulations prevented the application, prior to that date, of the liberalizing law rule stated in Karnas. Accordingly, the Court held that for any date prior to November 7, 1996, the Board could not apply the revised mental disorder rating schedule to a claim. Upon review of the above-discussed "old" criteria and the "new" criteria and the veteran's symptoms attributable to her PTSD, the Board concludes that in this case the "old" criteria should be applied, as it is more favorable to the veteran. As such, the above-discussed implications of Rhodan are not applicable. Rhodan, supra. Under the former criteria, found at 38 C.F.R. § 4.132, Diagnostic Code 9411 (1996), a 100 percent rating required that the veteran's attitudes of all contacts except the most intimate were so adversely affected as to result in virtual isolation in the community. It required 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. The veteran had to be demonstrably unable to obtain or retain employment. A 70 percent rating required that the veteran's ability to establish and maintain effective or favorable relationships with people was severely impaired. The psychoneurotic symptoms were to be of such severity and persistence that there was severe impairment in the ability to obtain or retain employment. A 50 percent rating required that the veteran's ability to establish or maintain effective or favorable relationships with people was considerably impaired. By reason of psychoneurotic symptoms the reliability, flexibility and efficiency levels were so reduced as to result in considerable industrial impairment. Note 1 to that code provides that social impairment per se will not be used as the sole basis for any specific percentage evaluation, but is of value only in substantiating the degree of disability based on all of the findings. As noted above, for a 70 percent evaluation under the former criteria, the evidence must show that the veteran's ability to establish or maintain effective or favorable relationships with people was severely impaired, in that the psychoneurotic symptoms were of such severity and persistence that there was severe impairment in the ability to obtain or retain employment. In reviewing the relevant evidence of record relating to the period from August 6, 1996 to November 3, 1997, the Board finds that such has not been shown. A November 1996 VA psychiatric examination showed that the veteran looked depressed but was well oriented with good memory, judgment and insight. It was further noted that she was well motivated to treatment and was able to work, albeit at a much lower level. Her GAF scale score was 50, which is indicative or serious symptomatology, but her overall incapacity from her (service-connected) disability was noted to be mild to moderate. A Vet Center nurse's opinion in December 1996 was essentially a statement in support of the veteran's PTSD being related to service, which has already been established; the nurse did not classify the severity of the illness. VA outpatient clinic records dated in late 1996 and early 1997 show continued PTSD symptoms, although there was some indication of improvement, and the possibility of other nonservice-connected disorders were noted during this time, including dysthymia related to childhood experiences, a history of alcohol and drug abuse, and a personality disorder. A psychiatrist who examined the veteran in April 1997 also noted a GAF scale score of 50 but opined that the veteran's PTSD was productive of considerable impairment. In fact, the examiner used the precise language from the rating schedule for a 50 percent rating (former criteria). Other evidence shows that the veteran quit her job in June 1997, due, in her words, to stress, and has not been employed since that time, but her non-service connected chronic back pain has been reported as one reason for quitting that job, and there is no medical evidence that shows her PTSD alone precluded her employment at that time. As will be explained below, medical and other relevant evidence beginning in early November 1997 indicates that the veteran's PTSD has been productive of severe symptomatology and has precluded her ability to work, which supports a 100 percent rating under 38 C.F.R. §§ 4.16, 4.132, Code 9411. However, from the period August 6, 1996 to November 3, 1997, as the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not applicable, and a rating in excess of 50 percent for PTSD, under the former rating criteria, must be denied. 38 U.S.C.A. § 5107(b); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The Board further holds that, as the relevant medical evidence does not show that the veteran's PTSD was manifested by the criteria for a 70 percent rating under the new rating criteria (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 work-like setting); inability to establish and maintain effective relationships) as to warrant a 70 percent rating, from the effective date of the regulatory change, November 7, 1996, to November 3, 1997, a rating in excess of 50 percent during the period of time in question, under the revised rating criteria, is also not warranted. The November-December 1997 VA Vocational Rehabilitation report, which shows that the veteran began counseling on November 4, 1997, indicates that there was concern the veteran was not "stable" at that time, that her industrial capacity seemed to be severely affected, that she was in an "acute" stage of PTSD, that it appeared that her PTSD "grossly" affected her social and industrial ability to adapt, and that it was not believed that she was able to demonstrate "behaviors" which would enable her to obtain or retain employment. That report also indicated that the veteran's ability to maintain effective or favorable relationships with other people was "almost totally gone." Taken together, these symptoms resulted in a determination that a "vocation goal [was] not a feasible prospect for her at the present time," nor could the veteran even participate in independent living services. A VA psychiatrist who examined the veteran in January 1998 also noted a GAF scale score of 50 but concluded that the veteran's PTSD was productive of "marked" incapacity and essentially total industrial inadaptability. The mental status examination indicated a definite increase in symptomatology, included significant signs of depression and paranoid ideation. Subsequently dated lay evidence, including a statement from the veteran's son, suggests a profound increase in disability, including some delusional or psychotic behavior. Based on the foregoing, the Board finds that the veteran's PTSD symptomatology has been productive of severe symptomatology and total industrial impairment, beginning November 3, 1996. As a 70 percent schedular rating under the former criteria is warranted, the provisions of 38 C.F.R. § 4.16(c) (1996) must be addressed. That section provides that in cases in which the only compensable service-connected disability is a mental disorder assigned a 70 percent rating, 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 rating under the appropriate diagnostic code. The Board notes that service connection has been granted for only one disability, that being PTSD. Based on the totality of the evidence, including the December 1997 VA Vocational Rehabilitation report, the January 1998 VA psychiatric examination report, the veteran's employment history, her April 1998 personal hearing testimony, and the June 1998 statement from her son, the Board finds the evidence indicates the veteran's PTSD disability has precluded her from securing or following a substantially gainful occupation since November 3, 1997, thus warranting a 100 percent schedular rating under the former rating criteria, from that date. See 38 C.F.R. §§ 4.16, 4.132, Diagnostic Code 9411 (1996). ORDER A rating in excess of 50 percent for PTSD, from August 6, 1996 to November 3, 1997, is denied. A 100 percent rating for PTSD, from November 4, 1997, is granted, subject to the laws and regulations governing the award of monetary benefits. R. F. WILLIAMS Member, Board of Veterans' Appeals