Citation Nr: 0001742 Decision Date: 01/20/00 Archive Date: 01/28/00 DOCKET NO. 91-12 363 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUES 1. Entitlement to an increased rating for psychotic depressive reaction and post traumatic stress disorder (PTSD), currently evaluated as 50 percent. 2. Entitlement to a total disability rating based on individual unemployability due to service connected disabilities (TDIU). REPRESENTATION Appellant represented by: Paralyzed Veterans of America, Inc. ATTORNEY FOR THE BOARD M. Ferrandino, Associate Counsel INTRODUCTION The veteran had active service from September 1964 to October 1967. By rating decision in April 1969, service connection was granted for psychotic depressive reaction and a 50 percent evaluation was assigned. In August 1989, the veteran filed a claim for an increased rating for PTSD. This appeal arises from the October 1989 rating decision from the St. Petersburg, Florida Regional Office (RO) that determined that the veteran had symptoms of both a psychotic depressive reaction and PTSD and continued the 50 percent evaluation. A Notice of Disagreement was filed in December 1989 and a Statement of the Case was issued in January 1990. A substantive appeal was filed in October 1990 with no hearing requested. This appeal additionally arises from a March 1995 rating decision from the St. Petersburg, Florida RO that denied entitlement to individual unemployability. This issue was included in a Supplemental Statement of the Case in February 1997 to which a substantive appeal was filed in April 1997. This case was remanded in September 1991, May 1994, and September 1995 for further development. The case was thereafter returned to the Board. By rating action of March 1995, the RO listed as an issue entitlement to secondary service connection for polysubstance abuse. This was in response to a claim for service connection for alcoholism filed by the veteran's representative in 1991. The RO deferred handling this issue, pending the issuance of regulations and instructions from the VA. Thereafter, by rating action dated in October 1996, service connection for alcohol and drug abuse as secondary to the service-connected disability was denied. By letter dated in October 1996, the veteran was notified of this decision and of his appellate rights. In April 1997, the veteran's representative filed a notice of disagreement to this action. In August 1997, a Statement of the Case was issued on this matter. The veteran was notified that he had to file a substantive appeal within 60 days from the date of the letter or within the remainder, if any, of the one-year period from the date of the letter notifying him of the action that he appealed. No response was received within the period prescribed by law, and the RO did not certify this issue for appeal. FINDINGS OF FACT 1. The veteran's claim for a rating in excess of 50 percent for psychotic depressive reaction and PTSD is plausible, and all relevant evidence necessary for an equitable disposition of the appeal has been obtained by the RO. 2. Service connection is in effect for psychotic depressive reaction and PTSD, rated as 50 percent; residuals, right acromioclavicular joint separation, major, rated as 0 percent; and malaria, rated as 0 percent. The combined schedular rating is 50 percent. 3. Service connected psychiatric disorder does not result in more than considerable social or industrial impairment and does not result in deficiencies in most areas concerning occupational and social impairment. 4. The veteran is not precluded from performing all forms of substantially gainful employment as a result of his service connected disabilities. CONCLUSIONS OF LAW 1. The criteria for the assignment of a rating in excess of 50 percent for psychotic depressive reaction and PTSD have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. Part 4, including §§ 4.1, 4.2, 4.7, 4.10, 4.130, Diagnostic Code 9411 (as in effect prior to and from November 7, 1996). 2. The criteria for the assignment of a total disability rating based on individual unemployability due to service connected disabilities have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 3.340, 3.341, 4.15, 4.16, 4.19 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Factual Background The veteran's service records show that he was discharged for psychotic depressive reaction, chronic, severe, including moderate stress of duty in a combat zone and loss of several close buddies. Additionally, the veteran was treated for malaria. By rating action of April 1969, service connection for psychotic depressive reaction was granted with a 50 percent evaluation assigned. Additionally, service connection for malaria was granted with a 0 percent evaluation assigned. In August 1989, the veteran filed a claim for an increased rating for his service connected PTSD. Associated with the file were VA treatment records from July 1989 to August 1989 that show that in July 1989 the veteran was seen with complaints of being depressed. The veteran stated he had a flashback and "tore up his home"; he had been drinking. He reported that he slept little and had flashbacks of buddies who were killed in Vietnam. He drank alcohol excessively. He hit his wife during a flashback episode. The veteran was crying repeatedly. He had thought about killing himself at times. He reported hearing voices of soldiers calling out "help me". He complained of ringing in his ears. He additionally reported being nervous. He reported not being able to handle a full time job since service, due to the stress. He had been hospitalized several times. An additional record from July 1989 shows that the veteran complained of flashbacks. He had been jailed three times for drinking. On examination, the veteran was alert, friendly, not psychotic, not suicidal, abstracted well, had little insight, and questionable judgment. The diagnoses included PTSD and alcoholism. In August 1989, the veteran was seen with fears of loss of control. He wanted to be hospitalized. A VA hospital record shows that the veteran was admitted from August 1989 to September 1989. The veteran reported a history of PTSD and alcohol abuse. He attributed his problems to flashbacks and problems with his wife. The physical examination was within normal limits except for generalized tremulousness. The diagnoses included PTSD and continuous alcohol dependence. A VA hospital record shows that the veteran was admitted from September 1989 to December 1989 for PTSD and alcohol abuse. He had been released recently from jail. He was currently having difficulties with his wife. During treatment, the veteran improved. He discussed his longstanding problems of anger, low frustration tolerance, overall fear of a crowd, and an inability to function on the outside. Upon discharge it was felt that the veteran could continue with further care as an outpatient, he was not felt to be suicidal or homicidal, his depression was in control, he was not psychotic, he had good reality testing, and he was able to acknowledge his behavior. The diagnoses included alcohol dependence, PTSD by history, and history of psychosis, but no evidence of this during admission. The GAF at the time of admission was 45, at the time of discharge the veteran's GAF was 71. By rating action of October 1989, it was determined that the veteran had symptoms of both psychotic depressive reactions and PTSD, and a 50 percent evaluation was assigned for the combined disability. The current appeal to the Board arises from this action. A VA hospital record shows that the veteran was admitted in February 1990 for heavy alcohol intoxication. He additionally complained of flashbacks of the people he killed in Vietnam, and had vague suicidal thoughts prior to admission. On examination, the veteran's speech was clear, and his affect and mood were constricted. He admitted to flashbacks of Vietnam, denied current suicidal ideation, appeared intact cognitively, and his insight and judgment were adequate. The veteran was granted a discharge against medical advice. Issues of employability were not addressed. The diagnoses included alcohol dependence and history of PTSD. Associated with the file was a VA outpatient record from May 1990 that shows that the veteran was depressed. He had frequent flashbacks of Vietnam experiences. The veteran indicated that when he had been hospitalized in the past he underreported the number of flashbacks he was experiencing due to embarrassment. The veteran was in need of hospitalization. A VA hospital record shows that the veteran was admitted from May 1990 to June 1990 for detoxification from alcohol. He gave a history of frequent flashbacks, both when drinking and when sober. During admission interview, the veteran was alert, well oriented, tremulous, cooperative, and casually dressed, with good hygiene. His speech was hesitant without looseness of association or flight of ideas. His thought processes were logical and mood was "good" with depressed affect. Memory, insight, and judgment were intact. Flashbacks, hallucinations, suicidal ideations, and homicidal ideations were denied at that time. The diagnoses included alcohol dependence and PTSD with secondary depression. The veteran was considered unemployable. A VA hospital record shows that the veteran was admitted from July 1990 to September 1990 with complaints of nightmares and flashbacks, fugue states, intermittent suicidal and homicidal behavior during fugue states (most recently in February 1990, when he shot another veteran and was currently on probation), poor short term memory, depression, and nervousness. The veteran requested to be discharged. The diagnoses included PTSD. A VA hospital record shows that the veteran was admitted from September 1990 to October 1990 for detoxification from alcohol. He had a history of PTSD. During the admission interview, the veteran was alert, oriented, anxious and tremulous; thought processes were logical and speech was coherent. Memory, concentration and abstractions were intact. The veteran admitted to hearing voices occasionally for many years. He had a history of suicidal gestures. Homicidal ideation was denied. The veteran described himself as a habitual criminal starting after Vietnam. The veteran's insight and judgment were poor. Discharge was granted for failure to comply with the treatment program. The diagnoses included alcohol dependence and PTSD. The veteran was considered able to resume any kind of work, including heavy, manual labor. A VA hospital record shows that the veteran was admitted from December 1990 to January 1991 with complaints of depression, auditory hallucinations, flashbacks, and suicidal ideations. During admission interview, the veteran was alert, oriented in 3 spheres and maintained fair eye contact; attention and concentration were poor; judgment was fair; memory was fair; and speech was good. He admitted to visual hallucinations of Vietnam friends and to hearing voices telling him to hurt himself. The veteran voiced some paranoid thoughts and thoughts of suicide everyday. Homicidal ideations were denied and mood was sad and nervous. The diagnoses included alcohol dependence and PTSD. The veteran was considered unemployable. A May 1991 notation from a VA physician indicated that the veteran was hospitalized in May 1991 for diagnoses to include adjustment disorder with depressed mood, and rule out major depression. A VA hospital report shows that the veteran was admitted in May 1991 with a chief complaint of being depressed and suicidal. He stated his medications were not working. He reported having flashbacks and hearing voices from Vietnam. He reported decreased sleep, decreased appetite, decreased energy and negative anhedonia. His history included a two year junior college degree. He was presently unemployed with his last job being in 1989 as a maintenance worker. On examination, the veteran was alert and oriented times 3, his speech was goal directed without errors, his thought form was negative for looseness of associations or flight of ideas, his thought content was positive for dissociative states and reported auditory hallucinations, his mood was depressed, his affect was congruent, and he had negative suicidal or homicidal ideation. The diagnoses included symptoms of PTSD and mixed personality disorder with antisocial personality disorder traits and borderline traits. Associated with the file was a VA hospital report from July 1991 that shows that the veteran was admitted with a longstanding history of PTSD and alcohol abuse. The veteran complained of nightmares, insomnia, night sweats and flashbacks related to Vietnam experiences. He additionally had guilt feelings and a depressed mood since leaving a drug treatment program. He complained of not eating. He had rage episodes and feelings of hopelessness, helplessness and worthlessness. He admitted to suicidal and homicidal thoughts. He had unexpected and uncontrollable crying spells. It was noted that the veteran was a poor historian. The veteran was given alcohol detox treatment. However, on the weekend prior to discharge the veteran returned to the unit with the odor of alcohol on his breath and a positive Breathalyzer, which led to his discharge. As to the veteran's PTSD, the veteran was put on medication which caused the auditory and visual hallucinations to cease. It was noted that the veteran was incompetent for VA purposes due to alcohol use. Otherwise, the veteran was competent if sober. The diagnoses included alcohol dependence and PTSD by history. The current GAF was 35. In the past year it was 67 and premorbid was 70. Associated with the file was a VA hospital report that shows that the veteran was admitted from November 1991 to January 1992 with a chief complaint of flashbacks and depression from hearing voices. On examination, the veteran was alert and oriented. His mood was labile and intermittently fearful. His affect and mood were congruent. He had poor eye contact. His thought content included auditory and visual hallucinations. He had paranoid delusions. Due to consumption of alcohol, the veteran had an irregular discharge. The diagnoses included PTSD and mixed personality disorder with antisocial and borderline traits. A VA social and industrial survey from November 1991 shows that the veteran had a history of depression and suicidal ideation. He had reported flashbacks, during which he became violent, destroying furniture, and shooting people. He had been diagnosed with history of alcohol dependence, symptoms of PTSD, history of polysubstance abuse, and mixed personality disorder with antisocial personality disorder traits and borderline traits. The veteran additionally had treatment for alcohol abuse. Additionally, the veteran had a history of legal problems and had been in prison. It was noted that the veteran was in the hospital and the report was not complete. VA treatment records from March 1992 shows that the veteran was a PTSD veteran who reported "tearing up" his residence during a flashback. He had a history of doing this. He denied being drunk currently. He requested admission to the hospital. On examination, the veteran was alert and oriented. He had suicidal thoughts. The diagnoses included PTSD and alcoholism. By rating action of June 1992, service connection for residuals right acromioclavicular joint separation (major) was granted as directly due to the veteran's service connected psychotic depressive reaction and PTSD. A 10 percent evaluation was assigned from November 1991 and a 0 percent evaluation was assigned from February 1992. VA outpatient records from March 1991 to July 1992 show that in March 1991, the veteran appeared healthy but anxious. In April 1991, the veteran was anxious but was able to talk openly about his situation. In May 1991, the veteran was seen with complaints of hearing voices, flashbacks and isolation. It was noted that he was service connected for psychotic depressive reaction. He reported poor concentration, leisure time problems and interpersonal problems. On examination, the veteran was anxious and had auditory hallucinations. The assessment included psychotic depressive reaction. The highest level of adaptive functioning during the past year was fair. Additional records from May 1991 show that the veteran was seen with complaints of depression, anxiety and suicidal thoughts. In July 1991, records show that the veteran attended a recreational therapy program on an irregular basis. He had poor motivation. The highest level of adaptive functioning was fair. He had not followed the prescribed treatment plan. In November 1991, the veteran was seen with complaints of injuring himself during a flashback and suicidal thoughts. The diagnoses included major affective disorder. In May 1992, on examination, the veteran was oriented times three. He had slowed speech. He had the shakes secondary to nerves. He denied hallucinations. He had suicidal thoughts in the past. The diagnoses included alcohol dependence and PTSD. It was noted that the veteran's employment status and consequence of drug use was disabled. A VA hospital record shows that the veteran was admitted from May 1992 to June 1992 for alcohol rehabilitation. He stated that he was currently unemployed. He complained of being depressed, and he had a history of suicide attempts. The diagnoses included alcohol dependence and PTSD by the veteran's history. VA outpatient records from July 1992 show that the veteran complained of a week long flashback. The veteran was alert and responsive; he had no abnormal movements; his mood was depressed; his affect was limited in range and intensity; there was no thought disorder; and the veteran was not suicidal at that time. He was admitted to the medical center. Associated with the file was an August 1992 VA hospital report that shows that the veteran complained of a two day history of drinking and having flashbacks upon early morning awakenings. He complained of homicidal and suicidal ideation. At the time of discharge, the veteran was no longer homicidal or suicidal and was experiencing no auditory or visual hallucinations and no flashback symptoms. The diagnoses included alcohol dependence, PTSD by history, and antisocial personality disorder. The current GAF was 45; GAF in the past year was 60 to 70. An October 1992 update to the November 1991 VA social and industrial survey shows that the veteran stated that he received no alcohol treatment prior to 1990 and had been treated two times for alcohol use. He had been recommended for a PTSD program. He reported that he had not had much employment since service. He reported numerous suicidal attempts, and flashbacks. He reported being a loner. It appeared to the examiner that consideration should be given to an increased evaluation for the veteran's depressive reaction and PTSD. On a VA examination in November 1992, the veteran reported being unemployed for many years, but tried to do odd jobs occasionally. He was not able to drive a car. He drank less than in the past. He avoided people. He graduated high school and had two years of college. He had been hospitalized two to three times a year for the past few years with a main diagnosis of alcohol dependence. He complained of being nervous, depressed, not sleeping well and having muscle tremors. On examination, the veteran was cleanly dressed and was tense. His speech was slightly slurred but relevant and coherent for the most part. He mentioned that he heard voices, but gave very little information. There was a paranoid coloring to some of his productions. His affect was blunted and his mood was depressed. His memory was good for remote events. His judgment and insight were poor. The diagnoses included alcohol dependence, rule out organic personality disorder, explosive type, and history of psychotic disorder not otherwise specified. A VA hospital report from January 1993 shows that the veteran complained of attempting to hurt himself during a flashback of Vietnam. He reported feeling depressed. He had no suicidal ideations and denied any hallucinations. He denied alcohol use since November 1992. During the hospital course, the veteran seemed not to be depressed. The diagnoses included possible adjustment disorder with mixed features, rule out PTSD. The GAF was 65 and the GAF of the past year was 65. A VA hospital report from July 1993 shows that the veteran complained of having flashbacks, hearing voices, being highly suicidal, and feeling depressed. He had lost weight, had decreased appetite, felt isolated, and felt anxious in crowds. He reported that alcohol use did not relieve his nervousness. It was felt that the veteran's polysubstance abuse and noncompliance with medications were the main cause for his current psychiatric symptoms and hospitalization. The veteran complained of some anxiety during his hospitalization, especially when informed of discharge. The anxiety also resulted in impulsive behaviors. It was felt that his impulsive attention-seeking behaviors were due to borderline personality disorder. The veteran reported flashbacks while hospitalized, but complained in a superficial nature. He described that his mood was gradually getting better. The veteran was noted to be interacting with peers on the unit and had a bright affect throughout the hospitalization. His appetite was good. It was felt that the veteran could be displaying some symptoms of organic delusional disorder secondary to his polysubstance abuse but it was unable to be discerned at that time. The discharge examination showed that the veteran was well groomed, cooperative, interacted well with peers and staff and he had euthymic mood and appropriate and bright affect. His speech was normal rate and tone with no disorganization. He denied suicidal ideation and homicidal ideation and any hallucinations or delusions. Cognition was grossly intact. His judgment was noted to be fair to poor. His insight was limited and poor. The diagnoses included polysubstance abuse, adjustment disorder with anxious factors, history of PTSD, and borderline personality disorder. The GAF was 55, in the last year it was 60. VA outpatient records from January 1993 to March 1994 show that in January 1993 the veteran hurt himself while having a flashback. He was very tense and shaky and felt suicidal. He requested hospitalization and was accepted for admission. The diagnoses included major affective disorder. In July 1993, the veteran complained of hearing voices, flashbacks and feelings of suicide. He requested hospitalization. The diagnoses included major affective disorder. In March 1994, the veteran reported drinking excessively. He reported that his psychiatric symptoms had gotten severe and he wanted to be admitted to the VA medical center. A VA hospital report shows that the veteran was admitted from March 1994 to June 1994 for alcohol rehabilitation. It was noted that psychological testing was completed and the veteran had a profile that was consistent with alcohol dependence. Issues were raised of social isolation and anger control as possible triggers to relapse. Prior to discharge, the veteran voiced no major subjective signs of depression. He was not psychotic and showed no overt manic signs. He was considered psychiatrically stable. He denied suicidal, homicidal, or aggressive thoughts, plans or intent. The diagnoses included alcohol dependence and cyclothymic disorder. He had a history of PTSD. His GAF was 50. On a VA examination in September 1994, the veteran reported not working. He had done mostly all kinds of different jobs. He claimed that he was unable to work due to his physical condition, and elaborated by saying that he basically had a nervous condition that caused him to be unable to work. He admitted he had been fired in the past for being verbally abusive. The veteran reported flashbacks of Vietnam experiences since service, he was scared of other people, he wanted to hurt other people, and he often would get depressed and suicidal. He had auditory hallucinations, ideas of reference, and delusions of persecutions. On examination, the veteran was shabbily dressed, hygienically unclean, and had speech problems due to missing teeth. His mood was depressed. His affect was somewhat blunt and he got easily agitated as the interview proceeded. He admitted to auditory hallucinations telling him to kill himself. He remained depressed with suicidal thoughts and homicidal behavior. The cognitive functions of orientation and memory appeared to be intact. The impression was PTSD, chronic, delayed, moderate; psychosis; and chronic substance abuse, namely alcohol. It was noted that consultation was requested to confirm his PTSD and psychosis and it was thought that is was moderate to severe and did impair his ability to function because of constant voices and problems with PTSD. By rating action of March 1995, entitlement to individual unemployability was denied. The current appeal to the Board arises from this action. On a VA examination in January 1996, the examiner indicated he had examined the veteran in September 1994. The veteran's history was confirmed. The symptoms of PTSD continued. It was the examiner's opinion that the symptoms were in the mild to moderate range. The veteran last worked 1 and 1/2 years ago and claimed that he could not work because of a nervous condition but once again could not be specific. His jobs in the past mostly consisted of being a laborer, which did not require extensive concentration or memory functioning. The veteran at this time continued to drink 1/2 gallon to a gallon of hard liquor a day. The impression was that the veteran would be able to hold gainful employment if he were not drinking. The service connected PTSD by itself would not prevent the veteran from gainful employment. The veteran's social integration had been hampered due to alcoholism rather than PTSD. In a March 1997 statement, the veteran's sister indicated that the veteran had PTSD related problems since returning from service, including difficulty falling or staying asleep, irritability or outbursts of anger, difficulty concentrating, hypervigilance, and exaggerated startle response. He had flashbacks and hallucinations, and withdrew from daily life with family and friends. This all had contributed to his unemployability and his temper tantrums and tension headaches. On a VA examination in February 1999, it was noted that the veteran appeared for the examination inebriated. He had a great deal of difficulty comprehending the questions or answering them directly. The veteran indicated that he had been in jail recently. The examiner was unable to do a usual survey of current symptoms, but the veteran mentioned that he was having flashbacks and mentioned in a very exaggerated sort of way that he had impulses to hurt himself. At no time was his affect anxious. On examination, the veteran had a tendency to exaggerate, in a vague sort of way, any answer that he gave to any questions. He was dressed neatly. He appeared reasonably well nourished and reasonably well groomed. It was difficult to estimate his intelligence level because of his slurred speech and inebriation. He did not exhibit affective problems. His speech did not have any classical thought disorder in it. He expressed no delusions. He spoke of no perceptual disorder. He was oriented to time, place, person and situation, but he seemed to be totally unable to answer a question that required a specific answer. He said that his memory was poor but he was unable to be tested for memory concentration, or abstraction ability. The diagnoses included continuous alcohol use and questionable PTSD, today he only spoke of flashbacks, and when he had been hospitalized in the past, PTSD was listed only by history and there were no recorded observations of flashbacks, nightmares, or startle reactions. The veteran's GAF could not be separated from alcohol because the veteran was clearly drunk. He was certainly functioning at a GAF of approximately 55. VA outpatient records from May 1999 to June 1999 show that in May 1999, the veteran was seen for alcohol dependence treatment. II. Analysis A. Increased rating Initially, the Board finds the veteran's claim for increased compensation benefits is "well grounded" within the meaning of 38 U.S.C.A. § 5107(a). The Court has held that, when a veteran claims a service connected disability has increased in severity, the claim is well grounded. Proscelle v. Derwinski, 2 Vet. App. 629 (1992). Furthermore, after reviewing the record, the Board is satisfied that all relevant facts have been properly developed. Thus, no further assistance to the veteran is required to comply with the duty to assist him, as mandated by 38 U.S.C.A. § 5107(a). While the veteran appeared inebriated at the last VA examination which interfered with the examiner's ability to assess his disability, this is due to the fault of the veteran and not to that of the VA. The duty to assist is not a one way street. Cooperation on the veteran's part is needed. Zarycki v. Brown, 6 Vet. App. 91 (1993). Under 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. VA has a duty to acknowledge and consider all regulations that 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). These regulations include, but are not limited to, 38 C.F.R. §§ 4.1 and 4.2. Also, 38 C.F.R. § 4.10 provides that, in cases of functional impairment, evaluations must be based upon lack of usefulness of the affected part or systems, and medical examiners must furnish, in addition to the etiological, anatomical, pathological, laboratory and prognostic data required for ordinary medical classification, full description of the effects of the disability upon the person's ordinary activity. These requirements for evaluation of the complete medical history of the claimant's condition operate to protect claimants against adverse decisions based upon a single, incomplete, or inaccurate report, and to enable the VA to make a more precise evaluation of the level of the disability and of any changes in the condition. Schafrath, 1 Vet. App. at 594. When there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Where entitlement to compensation has already been established, and an increase in the disability rating is at issue, it is the present level of disability which is of primary concern. Francisco v. Brown, 7 Vet. App. 55 (1994). The regulations pertaining to rating psychiatric disabilities were revised effective November 7, 1996. The Court has held that 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 the appellant will apply. Karnas v. Derwinski, 1 Vet. App. 308, 313 (1991). Under the "old" regulations pertaining to psychiatric disabilities in effect prior to November 7, 1996, a 50 percent evaluation required that the ability to establish or maintain effective or favorable relationships with people be considerably impaired and that reliability, flexibility and efficiency levels be so reduced by reason of psychoneurotic symptoms as to result in considerable industrial impairment. A 70 percent evaluation required that the ability to establish and maintain effective or favorable relationships with people be severely impaired and that the psychoneurotic symptoms be of such severity and persistence that there is severe impairment in the ability to obtain or retain employment. A 100 percent rating was assigned when the attitudes of all contacts except the most intimate are so adversely affected as to result in virtual isolation in the community; when there are 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 when the veteran is demonstrably unable to obtain or retain employment. 38 C.F.R. Part 4, Diagnostic Codes 9400-9502 (1995). The "new" regulations pertaining to rating psychiatric disabilities, in effect as of November 7, 1996, are found in 38 C.F.R. § 4.130, Codes 9201-9440 (1999) and are set forth in pertinent part below: General Rating Formula for Mental Disorders: Total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. 100 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. 70 Occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships. 50 38 C.F.R. § 4.130, Diagnostic Code 9411 (1999). The record does not support the veteran's claim for a rating in excess of 50 percent, under either the old or the new criteria for evaluating psychiatric disorders. The evidence shows that since August 1989, the veteran has been hospitalized on several occasions for disabilities to include a psychiatric disability and PTSD; however, the veteran's alcohol dependence was a primary factor in the hospitalizations. The veteran was considered unemployable in several VA hospital reports; however, the diagnoses again included alcohol dependence. On other hospital reports and the VA examination in January 1996, it was noted that the veteran was considered competent and employable if alcohol were not a factor and that alcohol and drug use caused him to be disabled. On the most recent VA examination in February 1999, the veteran was inebriated and based upon the examination performed, no psychiatric diagnoses were made separable from the veteran's inebriation. The VA examinations in this case constitute significantly more probative evidence inasmuch as they entail a comprehensive review of the veteran's medical history. Since September 1989, the veteran's Global Assessment of Function has ranged from 35, in July 1991, with a premorbid GAF of 70, to 45, 50, 55, 60, 65, 67, 70, and 71. The criteria to determine the correct score on this scale are found in the American Psychiatric Association's DIAGNOSTIC AND STATISTICAL MANUAL FOR MENTAL DISORDERS. A score between 31 and 40 contemplates some impairment in reality testing or communication or major impairment in several areas, such as work or school, family relations, judgment, thinking, or mood. A score between 41 and 50 contemplates serious symptoms or any major impairment in several areas, such as work or school, family relations, judgment, thinking, or mood. A score between 51 and 60 contemplates moderate symptoms or moderate difficulty in social, occupation, or school functioning (e.g., few friends, conflicts with peers or co-workers). A score between 61 and 70 contemplates some mild symptoms or some difficulty in social, occupational, or school functioning but generally functioning pretty well, has some meaningful interpersonal relationships. A score between 71 and 80 contemplates that if symptoms are present, they are transient and expectable reactions to psychosocial stressors; nor more than slight impairment in social occupational, or school functioning. Again, however, these evaluations were determined when the veteran was seen for a psychiatric disorder and for alcohol abuse treatment. Further, on the February 1999 VA examination, it was noted that the veteran's GAF of 55 was not separable from alcohol due to the veteran's inebriation. Accordingly, the undersigned finds that the veteran's psychotic depressive reaction and PTSD alone do not result in greater than considerable industrial impairment under the old regulations. The veteran additionally does not show symptomatology more closely analogous to that contemplated by the 70 percent evaluation under the current criteria. There is no evidence of 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 or neglect of personal appearance and hygiene due to the service connected disability as opposed to the substance abuse. When consideration is given to the symptomatology and to his occupational and social functioning attributable to his service connected disability, a rating in excess of 50 percent is not warranted. B. TDIU The veteran's claim of entitlement to TDIU benefits is well grounded within the meaning of 38 U.S.C.A. § 5107(a) (1991). That is, the Board finds that he has presented a claim that is plausible. The Board is also satisfied that all relevant evidence has been developed and that no further assistance is required to comply with the duty to assist under 38 U.S.C.A. § 5107(a). Total disability meriting a 100% schedular rating exists "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 (1999). Where the schedular disability rating is less than 100%, a TDIU rating may nonetheless be assigned if a veteran is rendered unemployable as a result of service-connected disabilities, provided that certain regulatory requirements are satisfied. See 38 C.F.R. §§ 3.341(a), 4.16(a) (1999). Pursuant to 38 C.F.R. § 4.16(a): 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 that, 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. With regard to 38 C.F.R. § 4.16(a), substantially gainful employment suggests 'a living wage'." Beaty v. Brown, 6 Vet. App. 532, 538 (1994) (quoting Ferraro v. Derwinski, 1 Vet. App. 326, 332 (1991)). A veteran who is unable to secure and follow a substantial occupation by reason of a service- connected disability shall be rated totally disabled. See 38 C.F.R. § 4.16(b). The veteran currently has a 50 percent rating for one service connected disability and noncompensable evaluations for the others. He, therefore, does not satisfy the minimum rating required by regulation for consideration of a TDIU claim (see 38 C.F.R. § 4.16(a)). Additionally, the record contains no competent evidence that the service connected disabilities, standing alone, without regard to advancing age or non- service connected disabilities preclude him from engaging in any substantially gainful employment. The veteran had a high school education and two years of college and additionally has worked as a laborer. As analyzed above, the veteran has been considered competent and employable but for his alcohol use. The evidence does not support the veteran's claim that his service connected disabilities prevent him from working, without regard to advancing age. Accordingly, the veteran is not precluded from performing all forms of substantially gainful employment due to his service connected disabilities, and the preponderance of the evidence is against his claim for TDIU benefits. ORDER Entitlement to a rating in excess of 50 percent for psychotic depressive reaction and PTSD is denied. Entitlement to a total disability rating based on individual unemployability due to service connected disabilities is denied. Iris S. Sherman Member, Board of Veterans' Appeals