Citation Nr: 0001674 Decision Date: 01/20/00 Archive Date: 01/28/00 DOCKET NO. 94-10 436 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Cleveland, Ohio THE ISSUE The propriety of the initial 30 percent schedular rating assigned for post-traumatic stress disorder (PTSD) from November 1, 1991 to February 17, 1992, and the 50 percent schedular rating assigned for PTSD from June 1, 1992 to July 31, 1993, and from October 1, 1993 to November 14, 1996. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD L. Cryan, Associate Counsel INTRODUCTION The veteran had active service from January 1968 to May 1970, including service in the Republic of Vietnam; his decorations include the Combat Action Ribbon, and the Purple Heart Medal. This case is before the Board of Veterans' Appeals (Board) on appeal from an April 1992 rating decision by the Cleveland, Ohio Regional Office (RO) of the Department of Veterans Affairs (VA) which granted the veteran service connection for PTSD and assigned a 30 percent schedular evaluation for that disability effective from November 1, 1991, following the expiration of a period for along with a temporary total rating in effect from August 16, 1991 to October 31, 1991. The veteran appealed this decision. The RO thereafter adjusted the effective date of the grant of service connection from August 16, 1991 to August 6, 1991 based on a finding of clear and unmistakable error in the August 1992 rating decision. During the pendency of the appeal, an RO rating decision dated May 1997 increased the veteran's PTSD evaluation to 50 percent effective from June 1, 1992. Thereafter, in April 1999, the RO granted a total rating effective from November 15, 1996. The Board notes, as a preliminary matter, that there has been some confusion as to the appropriate characterization of the issue(s) before the Board. The RO, the veteran's representative, and, in its April 1996 remand, the Board, have all characterized the issues as involving both entitlement to a higher evaluation for PTSD, and the [p]ropriety of reduction of evaluation from 100 percent to 30 percent for PTSD effective June 1, 1992." However, upon careful review of the claims file, the Board notes that the original schedular rating assigned was 30 percent, and the RO never reduced that rating. The temporary total rating assigned from August 6, 1991 to October 31, 1991 (like those assigned for periods in 1992 and 1993) is a rating assigned only for a period of hospitalization . The Board points out that the return to the 30 percent rating after the temporary total rating was not a reduction, but rather an expiration of the temporary period during which the veteran was hospitalized. from August 6, 1991 to October 31, 1991, As such, and excluding periods during which the veteran was awarded a temporary total evaluation for hospitalization (from August 6, 1991 to October 31, 1991, from February 18 , 1992 to May 30, 1992, and from August 1, 1993 to September 30, 1993) the Board finds that the issue is best characterized on the cover page of this decision. Because the veteran disagreed with the initial evaluation assigned for his PTSD, the Board has recharacterized the issue as involving the propriety of the initial rating assigned. See Fenderson v. West, 12 Vet. App. 119, 126 (1999). FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the appeal has been obtained. 2. During the period from November 1, 1991 to February 17, 1992, the veteran's PTSD was manifested by definite impairment in the ability to establish or maintain effective and wholesome relationships with people, depression, anxiety, sleep disturbance, flashbacks, nightmares, intrusive thoughts, irritability, hypervigilance, and survivor guilt, resulting in such reduction in initiative, flexibility, efficiency and reliability as to produce social and industrial impairment that is distinct, unambiguous, and moderately large in degree. 3. During the periods from June 1, 1992 to July 31, 1993, and from October 1, 1993 to November 14, 1996, the veteran's PTSD was manifested by a considerable impairment in the ability to establish or maintain effective or favorable relationships with people, no consistent suicidal or homicidal ideation (apart from during periods of hospitalization), survivor's guilt, nightmares, hypervigilance, and exaggerated startle response, resulting in overall considerable social and industrial impairment. CONCLUSIONS OF LAW 1. The criteria for an initial evaluation in excess of 30 percent for PTSD for the period from November 1, 1991 to February 17, 1992, have not been met. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. §§ 3.321, 4.1, 4.3, 4.7, 4.130, Diagnostic Code 9411 (1996). 2. The criteria for an evaluation in excess of 50 percent for PTSD for the periods from June 1, 1992 to July 31, 1992, and from October 1, 1993 to September 14, 1996, have not been met. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. §§ 3.321, 4.1, 4.3, 4.7, 4.130, Diagnostic Code 9411 (1996). REASONS AND BASES FOR FINDINGS AND CONCLUSION I. Factual Background Historically, the veteran served in Vietnam during 1968 and 1969. During that time, he sustained injuries from rocket attacks and he reportedly witnessed many soldiers get killed and/or burned during combat. The veteran's Form DD-214 shows that the veteran was awarded the Combat Action Ribbon and The Purple Heart Medal. Post-service medical evidence shows that the veteran was hospitalized at the Brecksville unit of the Cleveland VA Medical Center from August 6, 1991 to October 9, 1991. The inpatient hospital summary for that period indicated that the veteran recently underwent inpatient detoxification for alcohol, cocaine and marijuana. The veteran reported that he abused pain medication, alcohol, and other drugs as a result of his stress disorder. The veteran reported insomnia, frequent nightmares, and flashbacks, in addition to paranoia associated with cocaine use. Mental status examination revealed appropriate affect, a fair to good memory, and "okay mood.". The veteran denied current suicidal or homicidal thoughts. There were no delusions. After the initial admission and evaluation, the veteran received treatment from the Dual Diagnosis Unit where he attended individual and group therapy sessions. The veteran's condition was stable on discharge, his depression had improved dramatically, and no overt psychosis was noted. The veteran's prognosis was fair, and he was considered employable at that time. The veteran was afforded a VA psychological evaluation in October 1991, and a psychiatric examination in November 1991. A review of the October 1991 psychological evaluation shows that the veteran's free-floating anxiety was very high, and his depression was in the mild range. Suicide seemed unlikely. During the November 1991 psychiatric evaluation, the veteran appeared overtly depressed and anxious, although he remained cooperative throughout the interview. The veteran was not hallucinatory or delusional. The veteran showed poorly controlled free floating anxiety with exaggerated startle response when discussing his Vietnam experience. The veteran was oriented times three and there was no evidence of memory impairment. Psychiatric diagnosis based on DSM IIIR included PTSD in Axis I, along with alcohol abuse, cannabis abuse and cocaine abuse, all by history in remission. The examiner associated extreme stress with Axis IV. The examiner noted definite impairment in the veteran's psychosocial functioning with a GAF score of 55. In April 1992, the RO granted the veteran service connection for PTSD, assigning a 30 percent schedular evaluation, effective from November 1, 1991, following a period of a temporary total evaluation for hospitalization from August 16, 1991 through October 31, 1991. Dissatisfied with the initial 30 percent rating assigned, the veteran submitted a notice of disagreement in August 1992. Records added to the file subsequent to the issuance of the April 1992 rating action show that the veteran was hospitalized at the Cleveland VA Medical Center between February 1992 and May 1992 A hospital summary dated April 1992 shows that the veteran suffered from chronic PTSD with continued substance abuse. Borderline personality was diagnosed under Axis II, and the veteran's GAF score was recorded as 20. The veteran had suicidal and homicidal ideations, and as a result was temporarily placed in four leather restraints for self protection and the protection of others. Prior to the veteran's admission, he visited the Vietnam Memorial Wall at the Tri-C Metro branch. This contributed to the veteran's anxiety and depression, and caused him to develop homicidal and suicidal ideation. Upon admission, the veteran was pale and appeared under the influence of medication. His affect was flat. The veteran was preoccupied with survivor's guilt. The veteran was coherent and relevant and showed no psychotic symptoms, but admitted to having thoughts of "getting a gun to kill anyone." In August 1992, the RO issued a rating decision that addressed the veteran's disagreement with the initial 30 percent evaluation assigned following the grant of service connection for PTSD. Although the RO found that the 30 percent schedular evaluation assigned to the veteran's PTSD was appropriate, a temporary total rating for the recent period of hospitalization, from February 18, 1992 to May 31, 1992, was assigned. The RO sent a statement of the case to the veteran in August 1992. The veteran underwent VA examination in January 1993. The veteran's subjective complaints at that time included nightmares, violent outbursts and being withdrawn from people. The veteran appeared extremely restless and suspicious, and showed clear signs of hypervigilance and exaggerated startle response. The veteran reported severe insomnia. The examiner indicated that the veteran was still oriented without any severe signs or organisity and he was competent to manage his own funds. The examiner diagnosed PTSD by history along with alcohol and cocaine addiction in partial remission. Personality disorder, mixed with explosive and addictive elements was indicated under Axis II. The examiner estimated the veteran's GAF score at 55. A May 1993 rating decision and a May 1993 and supplemental statement of the case confirmed and continued the 30 percent schedular rating assigned to the veteran's PTSD. In July 1993, the veteran submitted a timely substantive appeal (via a VA Form 9, Appeal to the Board of Veterans' Appeals) with respect to the rating assigned for his PTSD. The veteran was once again hospitalized from August 1993 to September 1993. The hospital summary indicated that on admission the veteran felt depressed and had thoughts of suicide prior to admission. The veteran reported flashbacks, nightmares, and survivor's guilt. Mental status examination reported that the veteran's affect was constricted and that his mood was depressed. The veteran admitted feeling depressed, but denied suicidal ideation subsequent to his admission. The veteran was preoccupied with his Vietnam experience and admitted to drug and alcohol abuse. The veteran denied auditory hallucinations. Judgment and insight were fair. The veteran was diagnosed with PTSD and poly drug abuse, cocaine and alcohol. The examiner reported a GAF score of 40. A November 1993 rating decision confirmed and continued the veteran's 30 percent schedular evaluation for his PTSD. The RO also awarded the veteran a temporary total for his recent hospitalization from August 19, 1993 to September 30, 1993. The veteran was notified of the RO's actions in a November 1993 supplemental statement of the case. The case was placed on the Board's docket in December 1995. In an April 1996 remand, the Board noted that the veteran's most recent VA examination at that time was in January 1993. Consequently, no current assessment of the veteran's PTSD was available for review. In accordance with the VA's duty to assist the veteran in the development of his claim, the Board remanded the case back to the RO for the RO to obtain and associate with the claims file all outstanding VA treatment records followed by having the veteran undergo a social and industrial survey, then a thorough examination. In response to an RO request for outpatient treatments date through 1996, the RO subsequently received and associated with the claims file outpatient treatment records dated primarily in 1992 and 1993. These records show that the veteran sought frequent psychiatric outpatient treatment for his PTSD. The records indicate that the veteran struggled with interpersonal relationships. Notations indicated that the veteran often appeared angry, worthless, and hopeless. A November 1996 psychological evaluation indicated that the veteran's history (presented upon interview) and chart review were indicative of a diagnosis of PTSD in the severe range. The veteran continued to experience distress from the traumatic events that he incurred while in Vietnam. The distress appeared in the form of intrusive and avoidance symptomatology as well as physiological arousal. In addition, anger control/management continued to be difficult for him. Substance abuse appeared to be another concern. In addition, there appeared to be some personality characteristics which further complicated his symptomatology. The veteran was found competent to manage his financial affairs in his own best interest. Thereafter, a social and industrial survey was conducted in November 1996. The results indicated that the veteran was tense, anxious, depressed and angry. The veteran avoided people as the rule. He was very restricted in social interaction. Most of his time was spent ruminating about Vietnam. His attention span was short. There was evidence of PTSD resulting in very poor social interactive skills. On the same date in November 1996, the veteran was afforded a VA psychiatric examination. The examiner indicated that he had reviewed the veteran's claims file. At that time, the veteran's subjective complaints included experiencing nightmares, insomnia, and flashbacks of children and other soldiers being burned in Vietnam. The veteran indicated that he becomes easily angered. He stated that he heard voices at night, that he became easily startled, and that he kept a gun at his side at all times. The veteran also reported suicidal and homicidal ideation with thoughts of suicide every few weeks and depression most of the time. Objective findings indicated that the veteran was oriented to time, place and person. Memory for recent and past events was intact. The veteran's affect was depressed and tearful especially when he spoke about Vietnam. He became very anxious and shaky. Insight and judgment were good. The examiner diagnosed PTSD as well as alcohol, cocaine and marijuana dependence. The examiner noted a GAF score of 50 based upon a minimal level of functioning, lack of socialization, social withdrawal, heavy drinking and depression. The examiner assessed the veteran as incapable of functioning in both a social and industrial setting. In May 1997, the RO issued a rating decision and a supplemental statement of the case which increased the veteran's evaluation for his PTSD from 30 percent to 50 percent. The effective date of the increased evaluation was June 1, 1992. The veteran indicated that he received Social Security Disability benefits. The RO subsequently requested and received the veteran's disability records from the Social Security Administration in October 1997. A review of these records indicates that the veteran has been awarded benefits due to substance addiction disorder and anxiety related disorders. The RO thereafter issued a supplemental statement of the case in September 1998 in which in noted that the veteran's Social Security records were considered, and that the veteran's 50 percent evaluation for his PTSD was confirmed and continued. A social and industrial survey was conducted in January 1999. The social worker indicated that the veteran's medications includes Tegretol, Trazadone, Lorazepam, Diazepam, and Ambien. The veteran indicated that he receives outpatient treatment and is compliant with his medications. The veteran's PTSD symptoms as listed included frequent nightmares, daily flashbacks, poor sleep, poor appetite, panic attacks 2-3 times per week, self isolation, crying spells 2-3 times per day, mood swings, feelings of anger, feelings of rage, and problems with memory. The veteran reported that he is easily agitated and irritated. The veteran reported that he has suicidal ideation 2-3 times per week. The veteran reported that he keeps his windows closed and curtains drawn at all times and described feelings of paranoia. The veteran stated that he does not like being around people or in crowds. The veteran was appropriately dressed, and he was oriented times 3. The veteran's eye contact was fair. His mood was depressed and his affect was somewhat angry. The veteran was tearful at times during the interview due to his psychiatric symptoms to include depression, flashbacks, poor concentration, poor sleep, agitation, nightmares, and irritability. The veteran was unable to socially interact with others, rendering him unable to develop or maintain positive relationships. The evaluator determined that the veteran's PTSD prevents him from gainful employment, or the ability to look for employment. The evaluator assessed the veteran's social and industrial impairment to be severe at 70. The veteran also underwent VA examination in January 1999. At that time, the veteran reported feeling very depressed with homicidal and suicidal ideations. He felt hopeless and helpless. The veteran appeared very nervous, restless, shaky, and extremely agitated. The veteran reported insomnia, hypervigilance, exaggerated startle response, nightmares, flashbacks of Vietnam, avoidance of people and anything that reminds him of Vietnam. It was indicated that the veteran had a feeling of detachment from others with a restricted range of affect, and was unable to have feelings of love. Objective findings indicated that the veteran was fairly neat in appearance with his long hair, extremely nervous, restless, anxious and had shakiness of his lower extremities. He was constantly picking at his facial muscles. The veteran's mood was depressed. He indicated that he had no friends and that he did not want to be around people. The veteran had homicidal and suicidal ideations, delusions and hallucinations. He was oriented times three. His memory was fair. Judgment and insight were fair. The diagnosis was PTSD with depression and anxiety with psychotic features. Alcohol, marijuana, nicotine, and cocaine dependence by history. The examiner noted that the veteran psychosocial stressors were severe and provided a GAF score of 40 for the current and past year.. The examiner assessed a severe impairment of the veteran's social and industrial adaptability. The examiner opined that, due to the severity of the veteran's PTSD, the veteran was unable to function with others and he was unable to maintain any gainful employment. Thereafter, in April 1999, the RO increased the veteran's evaluation for his service-connected PTSD from 50 percent to 100 percent, effective November 15, 1996, the date of the November 1996 psychiatric examination. II. Legal Analysis In this case, the veteran contends that his PTSD was more severe than was represented by the 30 percent rating from November 1, 1991 to February 17, 1992; and the 50 percent rating assigned from June 1, 1992 to July 31, 1993, and from October 1, 1993 to November 14, 1996. Essentially, the veteran appears to assert that he is entitled to a 100 percent rating for PTSD since the effective date of the grant of service connection. As a preliminary matter, the Board finds that the veteran's claim is plausible and capable of substantiation and is therefore well grounded within the meaning of 38 U.S.C.A. § 5107(a) (West 1991); Caffrey v. Brown, 6 Vet. App. 377, 381 (1994); Proscelle v. Derwinski, 2 Vet. App. 629, 631-632 (1992). When a claimant submits a well-grounded claim, VA must assist him in developing facts pertinent to the claim. Id. The Board is satisfied that all available relevant evidence has been obtained regarding the claim and that no further assistance to the veteran is required to comply with 38 U.S.C.A. § 5107(a) (West 1991). Disability evaluations are determined by comparing a veteran's present symptomatology with criteria set forth in the VA's Schedule for Rating Disabilities, which is based on average impairment in earning capacity. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. Part 4 (1999). When a question arises as to which of two ratings apply under a particular diagnostic code, the higher evaluation is assigned if the disability more closely approximates the criteria for the higher rating. 38 C.F.R. § 4.7 (1999). After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the veteran. 38 C.F.R. § 4.3 (1999). The veteran's entire history is reviewed when making disability evaluations. See generally, 38 C.F.R. 4.1 (1999); Schafrath v. Derwinski, 1 Vet. App. 589 (1995). Before proceeding with its analysis of the veteran's claim, the Board finds that some discussion of the Fenderson case is warranted. In that case, the United States Court of Veterans Appeals (now known as United States Court of Appeals for Veterans Claims) (Court) emphasized the distinction between a new claim for an increased evaluation of a service-connected disability and a case in which the veteran expresses dissatisfaction with the assignment of an initial disability evaluation where the disability in question has just been recognized as service-connected. In the former case, the Court held in Francisco v. Brown, 7 Vet. App. 55, 58 (1994), that the current level of disability is of primary importance when assessing an increased rating claim. In the latter case, however, where, as here, the veteran has expressed dissatisfaction with the assignment of an initial rating, the Francisco rule does not apply; rather, the VA must assess the level of disability from the date of initial application for service connection and determine whether the level of disability warrants the assignment of different disability ratings at different times over the life of the claim - a practice known as "staged rating." In this case, the Board finds that a remand to consider "staged rating" is unnecessary because the RO, in effect, has already done so. Specifically, the RO considered the evidence at different time periods and made appropriate adjustments based on the changes in severity of the veteran's PTSD over time. Thus, the RO's actions are comparable to consideration of staged rating even though they were not explicitly stated as such. Hence, there is no prejudice to the veteran in the Board expressly considering staged rating consistent with the Fenderson decision, cited to above. The evaluation assigned for a service-connected disability is established by comparing the manifestations indicated in the recent medical findings with the criteria in the VA's Schedule for Rating Disabilities. 38 C.F.R. Part 4 (1999). When there is a question as to which of two evaluations should 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 (1999). The Board notes that during the pendency of the veteran's appeal, a revised rating schedule for mental disabilities became effective on November 7, 1996. In Karnas v. Derwinski, 1 Vet. App. 308, 312-13 (1991), the Court held, in pertinent part, that where the law or regulation changed after a claim had been filed but before the administrative or judicial appeal process had been concluded, the version most favorable to the appellant was to be applied, absent contrary intent. The Board would emphasize, however, that nothing in the final version of the revised regulations at issue in this case or in Karnas or its progeny can be construed as permitting application of the revised regulations prior to their effective date. Here, the revisions were effective only as of November 7, 1996, and the RO granted the veteran a maximum 100 percent evaluation from November 15, 1996. For purposes of this appeal, then, the veteran can only benefit from consideration of the revised regulations to evidence dated between November 7, 1996 and November 14, 1996. However, as there is no such evidence of record, there is no basis for consideration of the revised rating criteria, and the Board will limit is review to consideration of the former criteria only. The former rating criteria, set forth at 38 C.F.R. § 4.132, Diagnostic Code 9411 (1996), provided for assignment of a 30 percent schedular rating for psychiatric disability when the ability to establish or maintain effective or wholesome relationships with people is definitely impaired; and when by reason of psychoneurotic symptoms the initiative, flexibility, efficiency, and reliability levels are so reduced as to result in definite industrial impairment. The term "definite" has been interpreted as "distinct, unambiguous, and moderately large in degree," representing a degree of social and industrial inadaptability that is "more than moderate but less than rather large." VAOPGCPREC 9-93 (O.G.C. Prec. 9-93); see also Hood v. Brown, 4 Vet. App. 301 (1993), A 50 percent schedular rating is warranted for psychiatric disability in which the ability to establish or maintain effective or favorable relationships with people is considerably impaired; and in which by reason of psychoneurotic symptoms the reliability, flexibility and efficiency levels are so reduced as to result in considerable industrial impairment. A 70 percent schedular rating is warranted where the ability to establish or maintain effective or favorable relationships with people is severely impaired; and when the psychoneurotic symptoms are of such severity and persistence that there is severe impairment in the ability to obtain or retain employment. Finally, the former version of Diagnostic Code 9411 provided for assignment of a maximum 100 percent schedular rating for psychiatric disability in which: 1) the attitudes of all contacts except the most intimate are so adversely affected as to result in virtual isolation in the community; 2) 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 3) when the veteran is demonstrably unable to obtain or retain employment. The Court has held that the criteria of the former version of Diagnostic Code 9411 provided three independent bases for granting a 100 percent evaluation. See Johnson v. Brown, 7 Vet. App. 95 (1994). In addition, 38 C.F.R. § 4.16(c) (West 1996), which was repealed when the revised criteria for rating psychiatric disabilities became effective, provided that where the veteran's only compensable service-connected disability was a mental disorder that was assigned a 70 percent evaluation, and that mental disorder precluded a veteran from securing or following a substantially gainful occupation, the mental disorder must be assigned a 100 percent evaluation under the appropriate diagnostic code. In this case, the overall medical evidence shows that the veteran's PTSD has fluctuated in its level of severity, growing progressively worse since the initial date of the grant of service connection, excluding consideration the noted periods of hospitalization. Although the veteran's periods of hospitalization may paint a more severe disability picture than other periods, the RO has already accounted for those periods by providing the veteran with temporary total ratings in accordance with 38 C.F.R. § 4.29 (1999). During the period from November 1991 to February 17, 1991, the medical evidence shows that the veteran's affect was appropriate, and memory was fair to good. The veteran reported insomnia, nightmares, flashbacks, but denied homicidal and suicidal ideations, and there were no delusions. The veteran was considered employable at that time. Anxiety was high, but depression was mild. In November 1991, the veteran's GAF score was reported as 55. The Fourth Edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM- IV), indicates that scores between 51 and 60 reflect a moderate level of impairment, e.g., flattened affect, circumstantial speech, occasional panic attacks, or moderate difficulty in social, occupational or school functioning, e.g., having few friends or having conflicts with peers or co-workers. These symptoms are consistent with a 30 percent evaluation as they show definite overall social/industrial impairment; i.e., occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform tasks. During the periods from June 1, 1992 to July 31, 1993, and from October 1, 1993 to November 14, 1996, the evidence shows that the veteran appeared extremely restless and suspicious, and showed clear signs of hypervigilance and exaggerated startle response. During his January 1993 VA examination, for example, the veteran reported severe insomnia, nightmares, and violent outbursts. In addition to a PTSD diagnosis, the examiner noted a personality disorder, mixed with explosive and addictive elements, with an estimated GAF score of 55. Outpatient records during 1992 and 1993 show that the veteran sought psychiatric outpatient treatment for his PTSD on several occasions. As noted above, these records indicated that the veteran struggled with interpersonal relationships, and he often appeared angry, worthless, and hopeless. These symptoms clearly reflect an increase in disability; however, the Board finds that they fall short of the severe symptomatology warranted for at least a 70 percent evaluation. Thus, the Board finds that the level of impairment manifested during these periods is consistent with assignment of a 50 percent evaluation for considerable impairment in the ability to establish or maintain effective or favorable relationships with others as well as reduced efficiency levels resulting in considerable industrial impairment. However, the medical evidence developed in connection with the Board's April 1996 remand indicates that, by November 1996, the veteran's GAF score had dropped to 50 and below, and the veteran medical evidence suggested that the veteran may be incapable of functioning in both a social and industrial setting due to PTSD. A November 4, 1996 psychological evaluation report, for example, indicated that the veteran had no significant relationships and felt detached from others, and that his psychological impairment (complicated by substance abuse and personality characteristics was in the severe range; the examiner did not then provide any assessment as to the veteran's ability to obtain and maintain substantially gainful employment. The social work who evaluated the veteran on November 15, 1999 also focused primarily on the veteran's social impairment, indicating that the veteran had very poor social interactive skills. However, the report of the psychiatric examination conducted November 15, 1996, includes the examiner's assessment of a GAF of 50 specifically for PTSD (notwithstanding the fact that he also offered Axis I diagnoses of alcohol, cocaine and marijuana dependence and, inexplicably, indicated that there was no Axis II diagnosis for personality disorder). and his expressed opinion that the veteran was incapable of functioning in both a social and industrial setting. Thereafter, in January 1999, the veteran reported frequent homicidal and suicidal ideation. The veteran's GAF score was then estimated at 40, and the veteran was found unable to function with others. The examiner also expressly opined that the veteran was also unable to maintain any gainful employment. Hence, the January 1999 findings effectively confirmed the findings of the VA psychiatrist in connection with his November 15, 1996 examination of the veteran. In view of the foregoing, the Board finds that the RO correctly increased the veteran's evaluation to a maximum 100 percent from November 15, 1996, the date of the psychiatric examination clearly demonstrating, medically, that the former applicable criteria for a 100 percent evaluation had been met, notwithstanding the earlier award of SSA benefits. The Board has carefully considered the SSA award and all pertinent evidence developed prior to date of the assignment of the 100 percent schedular evaluation, and the Board does not dispute that such evidence reflects increasingly significant symptomatology, suggesting, primarily, increasing social impairment/inadaptability. The Board emphasizes that under the former applicable criteria, social impairment is to be considered only as it affects industrial inadaptability. See 38 C.F.R. § 4.129 (1996). Moreover, much of the evidence considered by the SSA in awarding disability benefits, such as the veteran's reports of VA hospitalization, has already been considered in assigning the veteran's three periods of temporary total evaluations for hospitalization. Aside from this evidence, however, the evidence developed prior to November 15, 1996 simply presents no medical basis for assignment of a 100 percent schedular rating prior to that date. As the Board concludes that the RO properly awarded the veteran an initial 30 percent schedular rating from November 1, 1991 to February 17, 1992, and a 50 percent rating from June 1, 1992 to July 31, 1993, and from October 1, 1993 to November 14, 1996, the claim must be denied. See 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. §§ 3.321, 4.1, 4.3, 4.7, 4.130, Diagnostic Code 9411 (1996). In reaching this decision, the Board also has considered the applicability of the benefit of the doubt doctrine. However, as the preponderance of the evidence is against the veteran's claim, that doctrine is not applicable in the instant appeal. See 38 U.S.C.A. § 5107(b) (West 1991); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57 (1991). ORDER A rating in excess of 30 percent for the period from November 1, 1991 to February 1992, and in excess of 50 percent for the periods from June 1, 1992 to July 31, 1993, and from October 1, 1993 to November 14, 1996, is denied. JACQUELINE E. MONROE Member, Board of Veterans' Appeals