Citation Nr: 0001395 Decision Date: 01/18/00 Archive Date: 01/27/00 DOCKET NO. 97-29 546A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Phoenix, Arizona THE ISSUES 1. Entitlement to an evaluation in excess of 30 percent for post-traumatic stress disorder (PTSD), prior to April 6, 1999. 2. Entitlement to an evaluation in excess of 70 percent for PTSD, effective April 6, 1999. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Appellant INTRODUCTION The veteran served on active duty from May 1968 to May 1971. This matter comes to the Board of Veterans Appeals (Board) from rating decisions of the Regional Office (RO). By rating decision dated in May 1997, the RO granted the veteran's claim for service connection for PTSD. A 10 percent evaluation was assigned, effective September 1996. The veteran disagreed with the assigned evaluation. Based on the receipt of additional evidence, including the report of a Department of Veterans Affairs (VA) examination conducted in September 1997 and the veteran's testimony at a hearing at the RO in January 1998, a hearing officer, in June 1998, increased the rating assigned for PTSD to 30 percent, effective September 1996. The veteran continued to assert that an increased rating was appropriate and, a 70 percent evaluation was ultimately assigned, effective April 6, 1999. Effective March 1, 1999, the name of the United States Court of Veterans Appeals was changed to the United States Court of Appeals for Veterans Claims ("the Court). FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the veteran's appeal has been obtained by the RO. 2. Prior to April 6, 1999, the veteran's PTSD was manifested by occasional depression and anger. 3. There was no evidence of panic attacks or impaired judgment. 4. PTSD was not productive of more than definite industrial impairment. 5. Currently, PTSD is manifested by no more than severe impairment, with no evidence of delusions, grossly inappropriate behavior or disorientation. CONCLUSIONS OF LAW 1. A rating in excess of 30 percent for PTSD prior to April 6, 1999 is not warranted. 38 U.S.C.A. § 1155, 5107(a) (West 1991); 38 C.F.R. § 4.132, Diagnostic Code 9411 (as in effect prior to November 7, 1996), as amended by 38 C.F.R. § 4.130, Diagnostic Code 9411 (effective November 7, 1996); Karnas v. Derwinski, 1 Vet. App. 308 (1991). 2. A rating in excess of 70 percent for PTSD, effective April 6, 1999 is not warranted. 38 U.S.C.A. § 1155, 5107(a) (West 1991); 38 C.F.R. § 4.132, Diagnostic Code 9411 (as in effect prior to November 7, 1996), as amended by 38 C.F.R. § 4.130, Diagnostic Code 9411 (effective November 7, 1996); Karnas v. Derwinski, 1 Vet. App. 308 (1991). REASONS AND BASES FOR FINDINGS AND CONCLUSION The initial question before the Board is whether the veteran has submitted a well-grounded claim as required by 38 U.S.C.A. § 5107. The Court has held that a well-grounded claim is one which is plausible, meritorious on its own or capable of substantiation. Murphy v. Derwinski, 1 Vet. App. 78 (1990). In this case, the veteran's statements concerning the severity of the symptoms of his service-connected PTSD that are within the competence of a lay party to report are sufficient to conclude that his claim is well grounded. Proscelle v. Derwinski, 2 Vet. App. 629 (1992); Espiritu v. Derwinski, 2 Vet. App. 492 (1992). No further development is necessary in order to comply with the duty to assist mandated by 38 U.S.C.A. § 5107(a). Factual background The service medical records disclose that the veteran received a fragment wound to the abdomen in April 1969, and that the wound was debrided. A psychiatric evaluation on the separation examination April 1971 was normal. Service connection is in effect for five disabilities, including residuals of a shrapnel wound of the abdomen, with retained foreign body in the liver, evaluated as 10 percent disabling. The veteran submitted a claim for service connection for PTSD in September 1996. VA outpatient treatment records dated from June to October 1996 have been associated with the claims folder. It was reported in June 1996 that the veteran had missed a week of classes at college because he could not get up in the morning. He related that he became depressed when he did not do the right thing. He would start something and then stop. He stated that he had slept poorly at night since Vietnam. He had no thoughts of suicide. An examination showed that the veteran was neat and cooperative. His affect was OK. His thoughts were coherent and there were no delusions or hallucinations. He was alert and oriented. His judgment and insight were OK. The assessments were major depressive episode and narcotic dependence. When seen the following month, the assessment was PTSD. It was reported that when the veteran was seen in September 1996, he was going to school, but had not studied for a test that day. He exhibited self-defeating behavior that he had had since Vietnam. It was noted that he was beginning to recognize the PTSD symptoms in himself. An examination revealed that he was nicely groomed, alert and thoughtful. The assessments were PTSD and polysubstance abuse. In October 1996, the veteran spoke of his difficulty in talking about Vietnam. The assessments were PTSD and depression. The veteran was afforded a VA psychiatric examination in November 1996. He indicated that he had a significant number of dreams or nightmares at night. He reported that he had flashbacks that were triggered by helicopters. He reported some difficulty with anger, but rather than lash out at others, he kept it in. He reported feeling especially angry toward bosses who he later realized were good bosses. He stated that his concentration was not the greatest. He had a lot of guilt feelings. He had mixed feelings about what the future might bring. On mental status evaluation, the veteran's immediate, recent and remote memory were intact. He was oriented in all spheres. His speech was rapid, although generally normal. Thought processes production was spontaneous and abundant. Continuity of thought was goal-directed and logical. Thought content contained no suicidal or homicidal ideation. There were no ideas of reference, feelings of unreality or delusions. His abstract ability for similarities and proverbs was good. Concentration, as measured by serial 7's, was also good. The veteran described his mood as "tired." The examiner evaluated his mood as euthymic and his range of affect as broad. He was alert, responsive and cooperative throughout the examination. His judgment was good, and his insight fair. The Axis I diagnoses were PTSD, chronic; alcohol dependence, sustained full remission; and cocaine and heroin abuse, sustained full remission. The Global Assessment of Functioning score was 65. Based on the evidence described above, the RO, by rating action dated in May 1997, granted service connection for PTSD and assigned a 10 percent evaluation, effective September 1996. Additional VA outpatient treatment records dated in 1996 and 1997 are of record. In February 1997, the veteran noted a problem with poor concentration. It was suspected that his underlying anger resulted in rebelliousness that ultimately was self-destructive. This appeared to be a pattern of behavior with the veteran. It was noted that his mood was euthymic. He was friendly and cooperative. There was some anxiety, but it was not severe. There was no evidence of a psychotic thought process. The impressions were probable PTSD; major depressive disorder; and polysubstance abuse, in remission. Later that month, it was stated that he appeared stressed. In March 1997, the veteran was nicely groomed, and seemed relaxed. He had been accepted into a golf academy to learn to be a golf pro. In June 1997, the veteran's need to fail and never outshine others was discussed. Later that month, he continued to be concerned about his self-defeating behavior, inertia, procrastination, avoidance of possible failure, probably from underlying excessive expectations of himself and passive aggressive personality traits. His mental status was unchanged. There was low grade dysphoria. His issues were mostly characterological and not amenable to psychopharmacology. The impressions were PTSD and major depression, in remission. Another VA psychiatric examination was conducted in September 1997. The veteran continued to have problems with nightmares, flashbacks, anger, concentration and depression. There was essentially no change in the symptomatology from the previous VA examination. The veteran continued to report that he did not want to get close to people because "they will die." He expressed concerns about difficulty on the job. He stated that his pattern was to get angry and quit. He was working part-time selling subscriptions door-to-door. He had been made a supervisor, but this was too stressful for him and he quit for about two weeks. He was working about fifteen hours a week. On mental status evaluation, the veteran's immediate, recent and remote memory were good. He was oriented in all spheres. His speech was rapid and normal. Thought process production was spontaneous. Continuity of thought was goal-directed and logical. Thought content contained some mild preoccupation with anger and resentment at the VA system. There were no suicidal or homicidal ideations. There were no delusions, ideas of reference or feelings of unreality. His abstract, ability as measured by similarities, was concrete. He gave a good interpretation of the proverb presented to him. Concentration, as measured by serial 7's, was good. The veteran reported his mood as "tired, angry." The examiner evaluated his mood as euthymic and his range of affect as broad. He was alert, responsive and cooperative. His judgment was good, and his insight fair. The diagnoses were PTSD, chronic; alcohol dependence, sustained full remission; and cocaine and heroin abuse, sustained full remission. The Global Assessment of Functioning score was 65. VA outpatient treatment records show that the veteran was seen in October 1997 and he was mildly anxious. His mood was euthymic. The impressions were PTSD and major depression, in remission. In a statement dated January 1998, B.J.F. indicated that he met the veteran in 1994. He noted that the veteran seemed to have a problem getting too close to people. He noticed that the veteran was falling into a deep depression and sometimes would become so depressed that he would not leave his house for days at a time. In January 1998, J.P.M. related that he had met the veteran about four years earlier. It was apparent to him that the veteran did not always complete tasks or goals he had set for himself. He noted that while attending college, the veteran would not go to class for days at a time and remained alone in his apartment. A statement was also received in January 1998 from the veteran's mother, who described his life following his return from Vietnam. In June 1998, a hearing officer, based on the evidence summarized above, as well as the veteran's testimony at a hearing at the RO in January 1998, increased the rating assigned for PTSD to 30 percent, effective September 1996. The veteran continued to disagree with this rating. Additional VA outpatient treatment records dated in 1997 and 1998 have been associated with the claims folder. In December 1997, the veteran stated that he continued to have his ups and downs, and that he continued to be disappointed with himself. He had failed one class at school. He noted that he always seemed to fail something. He fought with his boss and lost his job. He had started a job in telemarketing, but was not real pleased with it or his co- workers. He was noted to be clean and neat, as always, but seemed unhappy. The assessment was PTSD. The veteran related in January 1998 that he had experienced an episode of immobilizing depression over the holidays. He spent two days in bed. Inertia and insomnia were noted. He had ongoing PTSD symptoms with recent exacerbation. He had started school again. An examination revealed that he was mildly dysphoric. There was some mood depression. No suicidal ideation was indicated. He was pleasant, cooperative and somewhat compulsive. He continued to have the spectrum of PTSD symptoms. The impressions were PTSD and major depression, in partial remission. VA outpatient treatment records also disclose that the veteran was again seen in January 1998 and he stated that he had started in school again and was already feeling anxious. He reported that he was sleeping only three hours a night. The assessments were PTSD, depression and compulsive. In March 1998, the veteran stated that he was doing all right in school, but was puzzled by his lack of motivation and his tendency to miss classes. This seemed all the more amazing to him because there were classmates who became angry about his cavalier attitude. He was noted to be well-groomed and thoughtful. The assessments were PTSD and polysubstance abuse in remission. In April 1998, it was reported that his mental status was basically unchanged. He was less depressed than on the previous visit. The impressions were PTSD and major depression, in remission. It was also noted that month that the veteran related that he had a hard time getting up in the morning for school. He stated that he was aware that his PTSD symptoms were a significant part of this. There was some depression, but in general he was doing well. He worried if he would be able to maintain his job with his current lack of motivation. On examination, he was alert and oriented times three. He was neatly groomed, relevant and coherent. His mood was mildly depressed. He was not suicidal or homicidal. The assessments were PTSD and major depression, in partial remission. In July 1998, it was noted that he was doing well, and in the past weeks, had been focused on his finals. He was due to graduate in August. He was noted to be friendly and cheerful. His mood was more elevated, with no evidence of psychosis. He was future- oriented. The assessments were PTSD and major depression. The veteran was admitted to a VA hospital on April 6, 1999. He reported feeling depressed, angry and he was staying in his house all the time. He admitted to intrusive thoughts, nightmares, feelings of suspiciousness to any noise and having passive thoughts of suicide, but no plans or intent. He admitted to drinking a pint of rum a day for the past several days, and to using cocaine. He denied symptoms of mania or psychosis. On mental status evaluation, it was noted that the veteran lived by himself. He was clean, cooperative, oriented and pleasant for the interview. His affect was full range and his mood was benign. His speech was linear. There was no thought disorder as to form or content. He had no perceptual or cognitive complaints. Throughout the hospitalization, the veteran was not a behavioral problem. There was no evidence of psychosis or severe depression. He had not been complaining of PTSD symptoms. He was improved and stable on discharge. The Axis I diagnoses were PTSD, alcohol dependence and cocaine abuse. The Global Assessment of Functioning score was 70. The veteran was afforded a VA psychiatric examination in May 1999. He complained that he stayed in bed all the time and that he got angry with people. The veteran reported that he slept during the day because he was unable to sleep at night. He stated that about once a week, he would have a combat- related nightmare that included sweats. He also indicated that once he had a nightmare, he was unable to get back to sleep. He complained of a lack of concentration. He described flashbacks, and estimated that they occurred about twice a month. He described their duration as brief, but they made him "jumpy" the rest of the day. He reported continuing problems with anger and irritability. He related some feelings of depression, including some suicidal ideation, most recently a week or so ago. He demonstrated the continued presence of hypervigilance, particularly for unknown noises. The veteran reported that he had been fired from his part-time job about three weeks earlier. He had been working at that job "on-and-off the last two years." He indicated that his boss told him that he was missing too many workdays and, as a result, he got angry, and his boss fired him. The veteran denied any social activities, except for going to a bar. On mental status evaluation, the veteran's immediate, recent and remote memories were good. He was oriented in all spheres. His speech was normal. Thought process production was spontaneous and abundant. Continuity of thought was goal-directed and logical. Thought content contained no suicidal or homicidal ideation. There were no delusions, ideas of reference or feelings of unreality. His abstract ability was good. Concentration was also good. His mood was euthymic and his range of affect broad. He was alert, responsive and cooperative. His judgment was good, and his insight fair. The diagnoses were PTSD, chronic, alcohol dependence, and heroin and cocaine abuse, sustained full remission. The Global Assessment of Functioning score was 50. Analysis Under the applicable criteria, disability evaluations 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; 38 C.F.R. Part 4. Separate diagnostic codes identify the various disabilities. The VA has a duty to acknowledge and consider all regulations which are potentially applicable through 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 (1991). 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. Although a rating specialist is directed to review the recorded history of a disability in order to make a more accurate evaluation, see 38 C.F.R. § 4.1 (1999), the regulations do not give past medical reports precedence over current findings. Francisco v. Brown, 7 Vet. App. 55 (1994). The degree of impairment resulting from a disability involves a factual determination of the severity of the disability. Since the veteran's claim for PTSD has been in continuous appellate status since the filing of his notice of disagreement, the Board's inquiry must be upon all medical and lay evidence of record reflecting the severity of his disability since the submission of his claim. See Fenderson v. West, 12 Vet. App. 119 (1999). On and after February 3, 1988, the Schedule for Rating Disabilities was amended to read as follows: General Rating Formula for Psychoneurotic Disorders: The attitudes of all contacts except the most intimate are 100% 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. Ability to establish and maintain effective or favorable 70% 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. Ability to establish or maintain effective or favorable 50% 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. Definite impairment in the ability to establish or 30% maintain effective and wholesome relationships with people. The psychoneurotic symptoms result in such reduction in initiative, flexibility, efficiency and reliability levels as to produce definite industrial impairment. Less than criteria for the 30 percent, with emotional 10% tension or other evidence of anxiety productive of mild social and industrial impairment. There are neurotic symptoms which may somewhat adversely 0% affect relationships with others but which do not cause impairment of working ability. 38 C.F.R. § 4.132, Diagnostic Code 9411 (as in effect prior to November 7, 1996). Words such as "mild", "considerable" and "severe" were not defined in the VA Schedule for Rating Disabilities. Rather than applying a mechanical formula, the Board must evaluate all of the evidence to the end that its decisions are "equitable and just". 38 C.F.R. 4.6 (1999). It should also be noted that use of terminology such as "mild" by VA examiners and others, although evidence to be considered by the Board, is not dispositive of an issue. All evidence must be evaluated in arriving at a decision regarding an increased rating. 38 C.F.R. §§ 4.2, 4.6 (1999). In Hood v. Brown, 4 Vet. App. 301 (1993), the Court 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 or bases" for its decision. 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). The Board must next address whether the application of O.G.C. Prec. 9-93 on appeal would be in violation of Bernard v. Brown, 4 Vet. App. 384, 392-394 (1993). The Board notes that Bernard expressly addressed circumstances in which statutory or regulatory provisions or analyses provided under the case law of the Court had not been considered by the agency of original jurisdiction. O.G.C. Prec. 9-93 does not fall explicitly into one of those categories. Moreover, the opinion does not change the rating criteria provided by regulation; rather, it only construes what the term "definite" means. In this case, the veteran has been apprised of the governing law and regulations and has been provided adequate notice of the need to submit evidence or argument on the issue of entitlement to an increased rating for his psychiatric disorder. The appellant has exercised his right to have a hearing. The Board, therefore, finds that the veteran is not prejudiced by the application of O.G.C. Prec. 9-93. With these considerations in mind, the Board will address the merits of the claim at issue. On and after November 7, 1996, the Schedule for Rating Disabilities was amended. The pertinent provision now reads as follows: General Rating Formula for Psychoneurotic Disorders: Total occupational and social impairment, due to such 100% 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. Occupational and social impairment, with deficiencies 70% 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. Occupational and social impairment with reduced reliability 50% 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. Occupational and social impairment with occasional 30% decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events). Occupational and social impairment due to mild or transient 10% symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled by continuous medication. A mental condition has been formally diagnosed, but symptoms 0% are not severe enough either to interfere with occupational and social functioning or to require continuous medication. 38 C.F.R. § 4.130, Diagnostic Code 9411 (effective November 7, 1996). "The intended effect of [the revision] is to update the portion of the rating schedule that addresses mental disorders to ensure that it uses current medical terminology and unambiguous criteria, and that it reflects medical advances that have occurred since the last review." 61 Fed. Reg. 52695 (October 8, 1996). The Court has furnished guidance concerning the effect of an intervening change in VA regulations while an appeal is pending. In Karnas, 1 Vet. App. 308, 313, the Court stated: "where the law or regulation changes after a claim has been filed or reopened but before the administrative or judicial appeal process has been concluded, the version most favorable to appellant should and we hold will apply . . . ." The Board has therefore examined the three versions of the VA Schedule for Rating Disabilities in light of Karnas. As noted above, the Court has previously held that the rating criteria which were effective on February 3, 1988 were more favorable to veterans than the previous rating criteria. See Clark, 2 Vet. App. at 169; see also Fletcher v. Derwinski, 1 Vet. App. 394, 397 (1991). Because of the relatively recent promulgation, the 1996 rating criteria have not yet been subjected to similar Court scrutiny. The General Counsel of the VA concluded that it would have to be determined on a case-by-case basis, whether the amended regulation, as applied to the evidence in each case, was more beneficial to the claimant than the prior provisions. VAOPGCPREC 11-97 (March 25, 1997). The Board has also considered whether consideration of all the schedular criteria without first referring the matter to the RO would be in violation of the Court's holding in Bernard v. Brown, 4 Vet. App. 384 (1993). In essence, Bernard held that the Board could not adjudicate questions which had not been first decided by the RO. In deciding whether adjudication is permissible, the Board must first determine whether an appellant would be prejudiced by such action. See VA O.G.C. Prec. Op. 16-92; Bernard, 4 Vet. App. at 394. The Board believes that the veteran will not be prejudiced by consideration of an increased disability rating under all criteria which have been in effect during the pendency of the his appeal, because, as discussed above, those most favorable to him will be applied. It is noted that he has been apprised of both criteria in the statement of the case issued in July 1997. The Board cannot identify any harm to the veteran caused by such consideration. The record discloses that a 10 percent evaluation was initially assigned for PTSD, and was subsequently increased to 30 percent effective September 1996 and to 70 percent, effective April 6, 1999. The veteran continues to assert that a higher rating should be assigned for his service- connected psychiatric disability throughout the entire period in question. The evidence reflects the fact that the veteran was seen for outpatient treatment regularly in 1996 and 1997. While he variously reported that his symptoms included poor sleep and what was termed self-defeating behavior, the veteran was typically described as being well-groomed, coherent, oriented, and without delusions or hallucinations. While the VA examination in November 1996 revealed complaints of nightmares and flashbacks, his memory was intact, as was judgment. He did not have ideas of reference. At that time, the Global Assessment of Functioning score was 65. The outpatient treatment records in 1997 demonstrate he had continued problems with poor concentration and anger. Some anxiety was reported in February 1997, but it was not severe. He was described as relaxed in March 1997. While he expressed various complaints in June of that year, his mental status was noted to be unchanged. The findings on the VA psychiatric examination in September 1997 fail to establish that a rating in excess of 30 percent was warranted at that time. The examination showed only some mild preoccupation with anger and resentment. However, his concentration was good, he was alert, responsive and cooperative, and his judgment was good. it was again concluded that the Global Assessment of Functioning score was 65. The Board acknowledges that in January 1998, the veteran related that he had experienced immobilizing depression over the holidays, to the point where he remained in bed for two days. Additional symptoms included inertia and insomnia. Some depression in mood was observed on examination, and he was also noted to be compulsive. The fact remains, however, that the VA outpatient treatment records from 1998 reflect that he continued to describe problems involving motivation, but he was noted to have only some depression. He was described as doing well in April 1998. He was fully oriented and neatly groomed at that time. In addition, it was reported in July 1998 that he was scheduled to graduate the next month and that he was doing well. These findings summarized above do not show more than definite industrial impairment. He was apparently able to attend and complete school and, at various periods, he held a part-time job. In order to assign a rating in excess of 30 percent under the criteria which became effective in November 1996, the record must establish flattened affect, stereotyped speech, memory impairment or impaired judgment. The findings throughout the course of his outpatient treatment and on the VA examinations are most consistent with the 30 percent rating assigned prior to April 6, 1999. The medical findings on examination are of greater probative value than the statements of the veteran in support of his claim. With respect to the claim that a rating in excess of 70 percent is warranted effective April 6, 1999, in order to assign a higher rating, the current criteria require gross impairment in thought processes, persistent delusions or hallucinations, grossly inappropriate behavior, persistent danger of hurting self or others of disorientation. The Board notes that the veteran was hospitalized in April 1999 for symptoms associated with PTSD. He stated that he was depressed and staying in the house constantly. There was no indication of any thought disorder, and no evidence of a psychosis or severe depression. Similarly, the VA psychiatric examination of May 1999 demonstrates no memory impairment, delusions or impairment of judgment. Even under the criteria in effect prior to November 1996, a higher rating would not be warranted. While he has had at least one episode where he remained in the house for two days, the record does not show that he is virtually isolated in the community. There is no evidence of repudiation of reality, disturbed thought or panic as would warrant a 100 percent rating. Accordingly, the weight of the evidence is against the claim for an increased rating for PTSD. The veteran's statements concerning the severity of his psychiatric disability are of less probative value than the medical findings on examination. The Board has considered the application of Fenderson, 12 Vet. App. 119, and finds that the ratings assigned for the veteran's PTSD accurately reflect the level of the veteran's disability from the date of his claim and, therefore, staged ratings are not required. ORDER A rating in excess of 30 percent for PTSD prior to April 6, 1999 is denied. A rating in excess of 70 percent for PTSD, effective April 6, 1999, is denied. James R. Siegel Acting Member, Board of Veterans' Appeals