Citation Nr: 0004570 Decision Date: 02/22/00 Archive Date: 02/28/00 DOCKET NO. 96-08 093 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUE Entitlement to a total rating due to individual unemployability based upon service-connected disabilities. REPRESENTATION Veteran represented by: The American Legion ATTORNEY FOR THE BOARD C. L. Krasinski, Counsel INTRODUCTION The veteran served on active duty from November 1945 to May 1947 and from May 1948 to October 1956. This matter came before the Board of Veterans' Appeals (the Board) on appeal from rating decisions of the St. Petersburg, Florida, Department of Veterans Affairs (VA) Regional Office (RO). This matter was remanded to the RO by the Board in October 1997. FINDINGS OF FACT 1. The veteran's only service-connected disability is post- traumatic stress disorder (PTSD) with a history of conversion reaction, which is rated as 50 percent disabling. 2. The medical and other evidence or record indicates that the veteran's service-connected PTSD is principally manifested by nightmares, intrusive thoughts, chronic sleep impairment, and mild to moderate impairment in occupational and social functioning. 3. The veteran has a high school degree and has completed 2 years of college; he reported that he last worked full-time as a store manager from July 1982 to December 1982 and he worked as a chaplain in 1998 and 1999. 4. There is no evidence demonstrating that the veteran has experienced frequent periods of hospitalization or marked interference with employment due to his service-connected disability. 5. The veteran is not unemployable solely because of his service-connected disability. CONCLUSION OF LAW The criteria for the award of a total rating for compensation based upon individual unemployability have not been met. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. §§ 3.321, 3.340, 3.341, 4.15, 4.16, 4.130, Diagnostic Code 9411 (1999); 38 C.F.R. § 4.132, Diagnostic Code 9411 (1996). REASONS AND BASES FOR FINDINGS AND CONCLUSION The veteran is seeking a total rating based on individual unemployability due to his service-connected PTSD. In the interest of clarity, the factual background of this case will be reviewed. The pertinent law and regulations will be described. The issue on appeal will then be analyzed and a decision rendered. Factual Background In a March 1957 rating decision, service connection was established for conversion reaction. A 10 percent disability evaluation was assigned effective October 5, 1956. In a March 1984 rating decision, a 50 percent evaluation was assigned, effective August 2, 1983. A July 1988 rating decision established service connection for PTSD. This disorder was included with the service-connected conversion reaction. A 50 percent evaluation was assigned. A VA psychiatric examination was completed on a fee basis in December 1983. The veteran reported that he recently had to close his own business in the timber industry due to poor economic conditions "and also by his physical inability to sustain work." Diagnoses included dysthymic disorder, secondary to the veteran's economic circumstances; generalized anxiety disorder; and paranoid personality. VA hospitalization records dated from March 5, 1992 to April 2, 1992 reflect diagnoses of major depression, observation for dysthymia, cyclothymia, bipolar type 2, and PTSD by history. It was noted that the veteran felt frustrated because in 1983, degenerative disease of the lumbar spine caused him to retire and he had been unemployed since. In September 1995, the veteran filed a claim for a total rating based upon individual unemployability due to service- connected disabilities. He indicated that his service- connected PTSD prevented him from securing or following substantially gainful occupation. He reported that his disability affected his full-time employment in December 1982. The veteran reported that from July 1982 to December 1982, he worked as a store manager. He worked 40 hours a week and lost 6 days due to illness. The veteran stated that he worked as a cashier from April 1982 to January 1982; he worked 48 hours a week. He indicated that he lost 15 days due to illness. The veteran reported that he worked in light construction from June 1977 to November 1981. He stated that he tried to obtain employment in August 1984; he had applied for a cashier position. The veteran indicated that he had two years of college. He stated that his PTSD caused him not to be able to deal with the pressures of the job. He indicated that the strain caused him to become very nervous which affected his sleep and performance at work. The veteran reported that he was not receiving disability or retirement benefits. The veteran submitted copies of his medication prescriptions in support of his claim. The prescriptions indicated that the veteran was taking methocarbamol, diazepam, and propoxyphene. It was noted that these medication may cause drowsiness and that the veteran must use caution when driving or operating dangerous machinery. In a November 1995 statement, the veteran indicated that he had been disabled since 1982 due to his service-connected PTSD and his "nerves". He stated that since 1982, he has been on medication that precluded him from working. He indicated that his medication precluded him from driving or operating heavy machinery and the medication caused dizziness. In October 1997, the Board remanded this matter to the RO for additional development. In particular, the RO was to contact the veteran and obtain information concerning recent treatment he had received for his service-connected disability. The veteran was also to be scheduled for a VA examination to evaluate his service-connected PTSD. The record indicates that the veteran failed to respond to the RO's inquiry concerning treatment of PTSD. A May 1998 VA examination report indicates that the veteran had recurrent and intrusive distressing recollections of a motor vehicle accident in service. He made efforts to avoid activities and situations that aroused recollections of this incident. The veteran reported that he had feelings of detachment or estrangement from others, and chronic difficulty falling and staying asleep. The veteran reported that he had worked a number of jobs since service. He indicated that he last worked in 1976 and that he stopped working due to PTSD. He reported that he worked for the National Park Service and supervised 78 people. He stated that he was not fired but he was burned out. The examiner noted that the veteran was currently under a lot of stress due to his spouse's death two weeks prior. The veteran was taking Diazepam. Mental status examination revealed that the veteran did not have impairment of thought process or communication. He had no delusions, hallucinations, inappropriate behavior, or suicidal or homicidal thoughts. The veteran was able to maintain his personal hygiene and other activities of daily living. He was alert and oriented to time, place and person. He had no memory loss or impairment. He had no obsessive or ritualistic behavior. His speech was regular rate, rhythmic, and coherent. The veteran had no panic attacks. He described his mood as depressed and nervous. His affect was consistent with his mood. He had no impaired impulse control. He had chronic difficulty sleeping. The examiner indicated that the veteran was competent to handle his benefit payments. The Axis I diagnosis was PTSD. The examiner concluded that the veteran had mild occupational dysfunction due to his PTSD. It was noted that the veteran had mild economic problems. The examiner noted that the veteran was working as a chaplain and he had some support there. The veteran's Global Assessment of Functioning (GAF) score was 70, which reflected mild symptoms and some difficulty in social functioning and mild difficulty in occupational functioning due to his PTSD. It was noted that the veteran had a limited social support system and he had gained his primary support from his spouse, who had died less than two weeks prior. A June 1999 VA examination report indicates that the veteran had a long history of PTSD. It was noted that the veteran had experienced the death of his spouse within the past year. The veteran reported having nightmares two times a week. He had social isolation, increased irritability, depressed mood, and significant depression. He was tearful frequently. The veteran had a great deal of difficulty sleeping without the use of medications. His appetite was good and his energy was low. Memory and concentration were becoming increasingly difficult. The veteran indicated that his frustration tolerance was poor and he was more irritable with people. He had anhedonia and feelings of guilt surrounding his spouse's death. The veteran felt hopeless about the future and was looking forward to passing away. He had frequent thoughts of death, but denied any intent or plan to kill himself. It was noted that the veteran had been hospitalized multiple times in the past for his psychiatric disorder and he has had suicidal gestures in the past. He was currently followed at the VA outpatient clinic. His psychiatric medications included Selexa, Serax, and Trazodone. The examination report indicated that the veteran had a four year college degree. The veteran was gainfully employed after service until 1976, when he entered semi-retirement. He has a history of working as a minister and he currently served as a chaplain for two service department organizations. Examination revealed good hygiene and grooming. Mood was depressed. Affect was congruently tearful. Speech was normal in rate, tone, and volume. Thought process was linear and goal-directed, with occasional tangentially. The veteran denied auditory or visual hallucinations. There was no evidence of delusional thinking. The veteran has passive suicidal ideation without intent or plan. He denied homicidal ideation. Insight and judgment were fair. The examiner's assessment was that the veteran had a long history of PTSD and he had suffered the loss of his spouse approximately a year ago and he has not adequately grieved or come to terms with this loss. It was noted that the veteran's PTSD had not significantly changed over the past year. The veteran continued to have nightmares and intrusive memories, but his major difficulty appeared to be his depressed mood related to the loss of his spouse. The Axis I diagnosis was PTSD; major depressive disorder, recurrent, moderate; and alcohol abuse in remission. The veteran's GAF score for his PTSD was 55. The veteran's GAF score for his major depressive disorder was 40. His GAF score for his avoidant personality disorder was 60. The veteran appeared to have the capacity to handle his own funds. In a July 1999 rating decision, the RO evaluated the service- connected PTSD under the revised rating criteria for mental disorders, and continued the 50 percent disability evaluation for the PTSD. Pertinent Law and Regulations Disability ratings - in general Disability evaluations are determined by the application of VA's Schedule for Rating Disabilities (Rating Schedule), 38 C.F.R. Part 4 (1999). The percentage ratings contained in the Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and the residual conditions in civil occupations. 38 U.S.C.A. § 1155; 38 C.F.R. § 4.1 (1999). In determining the disability evaluation, the VA has a duty to acknowledge and consider all regulations which are potentially applicable based upon the assertions and issues raised in the record and to explain the reasons and bases for its conclusion. Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991). Governing regulations include 38 C.F.R. §§ 4.1, 4.2 (1999), which require the evaluation of the complete medical history of the veteran's condition. 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 concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Disability ratings - PTSD The Board notes that effective November 7, 1996, during the pendency of this appeal, the Rating Schedule, 38 C.F.R. Part 4, was amended with regard to rating mental disorders including PTSD. 61 Fed. Reg. 52695 (Oct. 8, 1996) (codified at 38 C.F.R. § 4.130). Because the veteran's claim was filed before the regulatory change occurred, he is entitled to application of the version most favorable to him. See Karnas v. Derwinski, 1 Vet. App. 308, 311 (1991). Before November 7, 1996, the Rating Schedule read as follows: General Rating Formula for Psychoneurotic Disorders: 100% 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. 70% 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. 50% Ability to establish or maintain effective or favorable 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. 38 C.F.R. § 4.132, Diagnostic Code 9411 (1996). On and after November 7, 1996, the Rating Schedule reads as follows: 100% Total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions of 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. 70% 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. 50% 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 effective work and social relationships. 38 C.F.R. § 4.130, Diagnostic Codes 9411 (1999). Total ratings based on individual unemployability It is the established policy of VA that all veterans who are unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities shall be rated totally disabled. 38 C.F.R. § 4.16 (1999). A finding of total disability is appropriate "when there is present any impairment of mind or body which is sufficient to render it impossible for the average person to follow a substantially gainful occupation." 38 C.F.R. §§ 3.340(a)(1), 4.15 (1998). "Marginal employment shall not be considered substantially gainful employment." 38 C.F.R. § 4.16(a). "Substantially gainful employment" is that employment "which is ordinarily followed by the nondisabled to earn their livelihood with earnings common to the particular occupation in the community where the veteran resides." Moore (Robert) v. Derwinski, 1 Vet. App. 356, 358 (1991). If the total rating is based on a disability or combination of disabilities for which the Schedule for Rating Disabilities provides an evaluation of less than 100 percent, it must be determined that the service-connected disabilities are sufficient to produce unemployability without regard to advancing age. 38 C.F.R. § 3.341 (1999). Total disability ratings for compensation may be assigned where the schedular rating is less than total when the disabled person is, in the judgment of the rating agency, unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities, provided that, if there is only one such disability, this disability shall be ratable at 60 percent or more, and if there are two or more disabilities, there shall be at least one disability ratable at 40 percent or more and sufficient additional disability to bring the combined rating to 70 percent or more. See 38 C.F.R. § 4.16(a) (1999). In evaluating total disability, full consideration must be given to unusual physical or mental effects in individual cases, to peculiar effects of occupational activities, to defects in physical or mental endowment preventing the usual amount of success in overcoming the handicap of disability and to the effects of combinations of disability. 38 C.F.R. § 4.15 (1999). Entitlement to a total rating due to individual unemployability must be established solely on the basis of impairment from service-connected disabilities and not based on nonservice-connected disabilities or advancing age. 38 C.F.R. § 4.19 (1999); Hodges v. Brown, 5 Vet. App. 375, 378- 379 (1993). The sole fact that a claimant is unemployed or has difficulty obtaining employment is not enough. And, although a high rating in itself is a recognition that the impairment makes it difficult to obtain and keep employment, the question remains whether the veteran is capable of performing the physical and mental acts required by employment, not whether the veteran can find employment. See 38 C.F.R. § 4.16(a); Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993). In Hatlestad v. Derwinski, 1 Vet. App. 164 (1991), the United States Court of Appeals for Veterans Claims (formerly the Court of Veterans Appeals) (Court) referred to apparent conflicts in the regulations pertaining to individual unemployability benefits. Specifically, the Court indicated there was a need for discussing whether the standard delineated in the controlling regulations was an "objective" one based on average industrial impairment or a "subjective" one based upon the veteran's actual industrial impairment. The Board is bound in its decisions by the regulations, the Secretary's instructions and the precedent opinions of the chief legal officer of VA. 38 U.S.C.A. § 7104(c) (West 1991). In a pertinent precedent decision, the VA General Counsel concluded that the controlling VA regulations generally provide that veterans who, in light of their individual circumstances, but without regard to age, are unable to secure and follow a substantially gainful occupation as a result of service-connected disability shall be rated totally disabled, without regard to whether an average person would be rendered unemployable by the circumstances. Thus, the criteria include a subjective standard. It was also determined that "unemployability" is synonymous with inability to secure and follow a substantially gainful occupation. VA O.G.C. Prec. Op. No. 75-91 (Dec. 27, 1991). Analysis The veteran asserts that his service-connected PTSD prevents him from securing or following a substantially gainful occupation. He contends that the medication that he takes for the PTSD precludes him from working. Review of the record reveals that the veteran's only service-connected disability is PTSD. A 50 percent disability evaluation is currently assigned to the PTSD. Initial matters - well groundedness of the claim/duty to assist/standard of proof Initially, the Board finds that the veteran's claim is well- grounded within the meaning of 38 U.S.C.A. § 5107(a). That is, he has presented a claim which is plausible. Murphy v. Derwinski, 1 Vet. App. 78 (1990). The veteran's has contended that he is precluded from gainful employment due to disabilities. Cf. Proscelle v. Derwinski, 2 Vet. App. 629 (1992). This matter was remanded to the RO in October 1997 so that the veteran could be afforded the opportunity to identify relevant medical evidence which had not been associated with the claim folder. The veteran was also to be scheduled for a VA psychiatric examination. The veteran was afforded VA examinations in May 1998 and June 1999. In a December 1997 letter, the RO requested the veteran to identify the health care providers who have treated him for the PTSD. The RO also requested the veteran to complete releases, so that the RO would be able to obtain the records identified by the veteran. The veteran did not respond to the December 1997 letter. The veteran's failure to identify health care providers and provide the RO with authorization for release for such treatment records effectively limits the RO's ability to obtain and consider such records in connection with the veteran's claim. With this in mind, the Board notes that the VA's duty to assist the veteran in developing the facts and evidence pertinent to his claim is not a one-way street, meaning that he cannot sit by when requested to submit evidence or report for examination. "If a veteran wishes help, he cannot passively wait for it in those circumstances where he may or should have information that is essential in obtaining the putative evidence." Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). For the reasons expressed above, the Board is satisfied that all relevant facts have been properly developed and the RO complied with the directives in the remand, to the extent possible. No further assistance is required to comply with the duty to assist the veteran mandated by 38 U.S.C.A. § 5107(a). Once the evidence has been assembled, it is the Board's responsibility to evaluate all of the evidence. See 38 U.S.C.A. § 7104(a). When there is an approximate balance of evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the veteran. 38 U.S.C.A. § 5107(b); 38 C.F.R. §§ 3.102, 4.3. In Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990), the Court stated that "a veteran need only demonstrate that there is an 'approximate balance of positive and negative evidence' in order to prevail." To deny a claim on its merits, the preponderance of the evidence must be against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996), citing Gilbert, 1 Vet. App. at 54. Discussion i. Evaluation of service-connected PTSD In essence, in order to evaluate the veteran's claim of entitlement to a total rating, the Board must evaluate the severity of his only service-connected disability, PTSD. As noted above, effective November 7, 1996, during the pendency of this appeal, the Rating Schedule, 38 C.F.R. Part 4, was amended with regard to rating mental disorders including PTSD. 61 Fed. Reg. 52695 (Oct. 8, 1996) (codified at 38 C.F.R. § 4.130). Because the veteran's claim was filed before the regulatory change occurred, he is entitled to application of the version most favorable to him. See Karnas v. Derwinski, 1 Vet. App. 308, 311 (1991). In October 1997, the Board remanded this claim so the RO could evaluate the veteran's PTSD under both the former and revised rating criteria. The record reflects that the RO evaluated the veteran's PTSD under both the former and the revised regulations. The RO provided the veteran notice of the revised regulations in a July 1999 rating decision. Thus, the Board finds that it may proceed with a decision on the merits of the veteran's claim without prejudice to the veteran. See Bernard v Brown, 4 Vet. App. 384, 393- 394(1993). The Board finds that the preponderance of the evidence is against the assignment of a disability evaluation in excess of 50 percent for the PTSD under the former rating criteria. There is no medical evidence that the PTSD causes severe impairment in the veteran's ability to establish and maintain effective or favorable relationships or severe impairment in the ability to obtain or retain employment. There is no medical evidence which demonstrates that the PTSD causes 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 causes a demonstrable inability to obtain or retain employment. The medical evidence of record establishes that the veteran has mild to moderate impairment due to the service-connected PTSD. The May 1998 VA examination report indicates that the veteran's GAF score due to PTSD, alone, was 70, which reflected mild symptoms and some difficulty in social functioning and mild difficulty in occupational functioning due to his PTSD. See Carpenter, supra. The June 1999 VA examination report indicates that the veteran's GAF score due to the PTSD was 55, which is indicative of moderate symptoms. Although there can be no doubt that the veteran's PTSD symptoms cause some impairment, there is no evidence that such impairment is of such severity as to warrant the assignment of a 70 percent or higher rating under the former rating criteria. The Board also finds that the preponderance of the evidence is against a rating in excess of 50 percent under the revised criteria. The Board recognizes that there is medical evidence of record indicating that the veteran has nightmares and intrusive thoughts due to the PTSD. He also had chronic sleep impairment, social isolation, and feelings of detachment or estrangement from others. As discussed above, the May 1998 VA examination report indicates that the veteran's GAF score was 70, which reflected mild symptoms, some difficulty in social functioning, and mild difficulty in occupational functioning. The June 1999 VA examination report indicates that the veteran had a GAF score of 55, which reflects moderate impairment. The medical evidence of record does not, however, establish occupational and social impairment with deficiencies in most areas such as work, school, family relations, judgment, thinking, or mood due to such symptoms as 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; spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances; or inability to establish and maintain effective relationships. There is no medical evidence of 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 oneself or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; or memory loss for names of close relatives, one's own occupation, or one's own name. The Board further notes that the evidence of record establishes that the veteran currently has a non service- connected major depressive disorder, with a GAF score 40, which reflects serious symptoms or serious occupational or social functioning. The June 1999 VA examination report indicates that the veteran's depressed mood was related to the loss of his spouse. In addition, the veteran has a diagnosed personality disorder which is not service connection. See 38 C.F.R. § 3.303, 4.9 [congenital or developmental defects such as personality disorders are not diseases or injuries within the meaning of the applicable legislation pertaining to the award of VA benefits]. In summary, the Board finds that the preponderance of the evidence is against a rating in excess of 50 percent under both the former and revised criteria for Diagnostic Code 9411. ii. Evaluation of claim for total rating In this case, as noted above, the veteran's only service- connected disability is PTSD which is 50 percent disabling. Thus, he does not meet the percentage rating standards for individual unemployability benefits under 38 C.F.R. § 4.16(a). However, under 38 C.F.R. § 4.16(b), consideration to such benefits on an extraschedular basis may be given. The question is whether his service-connected disability precludes him from engaging in substantially gainful employment (i.e., work which is more than marginal, that permits the individual to earn a "living wage"). Moore v. Derwinski, 1 Vet. App. 356 (1991). 38 C.F.R. § 4.16(b) states that rating boards should submit to the Director, Compensation and Pension Service, for extraschedular consideration all cases of veterans who are unemployable by reason of service-connected disabilities, but who fail to meet the percentage standards set forth in 38 C.F.R. § 4.16(a). The rating board, in accordance with 38 C.F.R. § 4.16(b), will include a full statement as to the veteran's service-connected disabilities, employment history, education and vocational attainment and all other factors having a bearing on the issue. An extraschedular evaluation may be approved provided the case presents such an exceptional or unusual disability picture, with such related factors as marked interference with employment or frequent periods of hospitalization. See 38 C.F.R. § 3.321(b)(1) (1999). The RO determined that the 50 percent evaluation adequately compensated the veteran for his impairment due to PTSD, and the RO did not submit the veteran's case submission to the Director of the Compensation and Pension Service for extraschedular consideration. The Board finds that the RO's failure to submit the case to the Director of the Compensation and Pension Service for extraschedular consideration is reasonable because there are no exceptional factors or circumstances associated with the veteran's disablement. The evidence of record establishes that veteran has a high school degree and two years of college education. The record further shows that the veteran was substantially and gainfully employed from service separation until 1976. He retired from the park service in 1976. The veteran last worked full-time as a store a manager from July 1982 to December 1982. The evidence shows that the veteran stopped working in 1983 due to a nonservice-connected back disorder. More recently, in 1998 and 1999, the veteran worked as a chaplain for two service organizations. The veteran contends that his PTSD precludes him from engaging in substantially gainful employment. After reviewing the record, the Board finds that the preponderance of the evidence is against this claim. As discussed in detail above, the medical evidence of record establishes that the service-connected PTSD causes mild to moderate social and occupational impairment. The May 1998 VA examination report indicates that the veteran's GAF score was 70, which reflects mild symptoms and some difficulty in social or occupational functioning, but generally functioning pretty well. The June 1999 VA psychiatric examination report indicates that the veteran's GAF score for the PTSD was 55, which reflects more moderate symptoms or moderate difficulty in social or occupational functioning. The veteran asserts that the side effects from his medication for the PTSD preclude him from working. However, he has not submitted any medical evidence which establishes that he currently has side effects from the medication. The veteran has submitted copies of his prescription which indicate that the medication may cause drowsiness. However, the veteran has not submitted any medical evidence which establishes that he actually does experience any such side effect. With respect to his own statements, as a lay person he lacks the capability to provide evidence that requires specialized knowledge, skill, experience, training or education, such as a medical diagnosis or an opinion concerning etiology. See Espiritu v Derwinski, 2 Vet. App. 492, 494-5 (1992). Therefore, the statements of the veteran on this subject do not constitute competent medical evidence. The veteran has at times contended that he stopped working due to his service-connected PRSD. See, for example, the September 1995 and May 1998 examination reports. However, in an earlier VA hospital report, in 1992, he reported being unemployed since 1983, when he retired due to degenerative disease of the lumbar spine. This is consistent with a more contemporaneous medical record, the December 1983 VA psychiatric examination report, in which the veteran indicated that he was unable to work due to physical disability. The Board has the duty to assess the credibility and weight to be given to the evidence. See Madden v. Gober, 125 F.3d 1477 (Fed.Cir. 1997) and cases cited therein. To the extent that that it must choose, the Board places greater weight on the earlier medical reports, in which he indicated that he could not work due to physical problems, since such reports are closer in time to the actual event in 1982. The evidence of record does not reflect any factor which takes the veteran outside of the norm. See Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993) (noting that the disability rating itself is recognition that industrial capabilities are impaired). There is no evidence showing that the veteran's service-connected PTSD markedly interferes with his ability to be employed other than that contemplated within the schedular standards. There is no evidence of record showing that the veteran's service-connected disability presents an unusual or exceptional disability picture or require frequent periods of hospitalization. Review of the record reveals that the veteran was last hospitalized for his psychiatric disorders in 1992. Thus, the Board concludes that the veteran is ineligible for an extraschedular consideration of these service-connected disabilities in accordance with 38 C.F.R. § 4.16(b). In sum, for the reasons and bases stated above, the Board has concluded that the preponderance of the evidence supports the conclusion that the veteran's service-connected PTSD does not prevent him from securing and following substantially gainful employment, and therefore, his claim of entitlement to a total rating is denied. ORDER Entitlement to a total disability rating based upon individual unemployability is denied. Barry F. Bohan Member, Board of Veterans' Appeals The Court has held that GAF scores are a scale reflecting the "psychological, social, and occupational functioning on a hypothetical continuum of mental health- illness." See Carpenter v. Brown, 8 Vet. App. 240, 242 (1995); Richard v. Brown, 9 Vet. App. 266 (1996) (citing the American Psychiatric Association's DIAGNOSTIC AND STATISTICAL MANUAL FOR MENTAL DISORDERS (4th ed.), p. 32). GAF scores ranging between 61 to 70 reflect some mild symptoms (e.g., depressed mood and mild insomnia) or some difficulty in social, occupational, or school functioning (e.g., occasional truancy, or theft within the household), but generally functioning pretty well, and has some meaningful interpersonal relationships. Scores ranging from 51 to 60 reflect more moderate symptoms (e.g., flat affect and circumstantial speech, occasional panic attacks) or moderate difficulty in social, occupational, or school functioning (e.g., few friends, conflicts with peers or co-workers). Scores ranging from 41 to 50 reflect serious symptoms (e.g., suicidal ideation, severe obsessional rituals, frequent shoplifting) or any serious impairment in social, occupational or school functioning (e.g., no friends, unable to keep a job).