Citation Nr: 0002953 Decision Date: 02/07/00 Archive Date: 02/10/00 DOCKET NO. 94-15 176 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Detroit, Michigan THE ISSUE Entitlement to an evaluation in excess of 50 percent for post-traumatic stress disorder. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESSES AT HEARINGS ON APPEAL Appellant and his son ATTORNEY FOR THE BOARD D. J. Drucker, Associate Counsel INTRODUCTION The veteran had active military service from October 1966 to June 1969. This matter comes to the Board of Veterans' Appeals (Board) on appeal from an April 1990 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Detroit, Michigan. That determination reduced the evaluation for the veteran's service-connected post-traumatic stress disorder (PTSD) from 30 percent to 10 percent disabling. The veteran disagreed with that action and initiated this appeal. Thereafter, in an April 1993 rating decision, the RO restored the 30 percent evaluation for PTSD. In June 1996, the Board remanded the veteran's claim to the RO for further evidentiary development. In April 1998, the RO assigned a 50 percent disability evaluation to the veteran's service-connected PTSD. FINDINGS OF FACT 1. All relevant evidence necessary for an equitable disposition of the veteran's claim was obtained by the RO. 2. The veteran's PTSD results in severe social and occupational impairment and is manifested by poor personal hygiene, recurrent nightmares and flashbacks, intrusive thoughts, poor concentration and judgment, explosiveness and social isolation. CONCLUSION OF LAW The criteria for a 70 percent rating for PTSD are met. 38 U.S.C.A. §§ 1155, 5107 (West 1999); 38 C.F.R. §§ 4.7, 4.132, Diagnostic Code 9411 (1996), prior to November 7, 1996; 38 C.F.R. §§ 4.125, 4.130, Diagnostic Code 9411 (1999), effective November 7, 1996. REASONS AND BASES FOR FINDINGS AND CONCLUSION The veteran's claim for an evaluation in excess of 50 percent for PTSD is plausible and capable of substantiation and, thus, well grounded within the meaning of 38 U.S.C.A. § 5107(a); see Proscelle v. Derwinski, 2 Vet. App. 629 (1992) (a claim of entitlement to an increased evaluation of a service-connected disability generally is a well-grounded claim). When a veteran submits a well-grounded claim, VA must assist him in developing facts pertinent to that claim. 38 U.S.C.A. § 5107(a). To that end, the Board remanded the veteran's case in June 1996 to afford him the opportunity to undergo further VA examination and to submit additional evidence in support of his claim. The medical reports and evidence submitted by the veteran are associated with the claims files, the Board is satisfied that all relevant evidence has been obtained regarding the veteran's claim and, therefore, no further assistance to him with respect to his claim is required to comply with 38 U.S.C.A. § 5107(a). In accordance with 38 C.F.R. §§ 4.1, 4.2, 4.41 (1999) and Schafrath v. Derwinski, 1 Vet. App. 589 (1991), the Board has reviewed the veteran's service medical records and all other evidence of record pertaining to the history of his service- connected PTSD, and has found nothing in the historical record that would lead to a conclusion that the current evidence of record is inadequate for rating purposes. In addition, it is the judgment of the Board that this case presents no evidentiary considerations that would warrant an exposition of the remote clinical histories and findings pertaining to the disability at issue. Factual Background Records dated from 1982 to 1988, from the Social Security Administration (SSA), document that the veteran was found totally disabled in November 1981. A May 1985 SSA disability determination record reflects a diagnosis of prolonged PTSD and a January 1988 record shows a primary diagnosis of major depression, recurrent, and a secondary diagnosis of PTSD. A May 1986 rating decision granted service connection for PTSD based upon service records indicating that he served in Vietnam during the Vietnam Era and was exposed to life- threatening situations and was diagnosed with PTSD. A noncompensable disability evaluation was assigned. VA hospitalized the veteran on multiple occasions for treatment of PTSD and once for alcohol dependence (in December 1990) according to medical records dated from 1987 to 1999. Treatment included individual and group therapy, occupational therapy and prescribed medication. In April 1989, the RO granted a 30 percent disability rating to the veteran's PTSD and, in April 1990, the RO reduced the disability evaluation from 30 percent to 10 percent, effective August 1, 1990. A February 1990 statement from Morris I. Goldin, M.D., documents that Dr. Goldin treated the veteran from November 1987 to November 1988. Dr. Goldin said that the veteran suffered from PTSD, his condition had not improved and his prognosis was poor. According to a March 1990 VA examination report, the veteran complained of finding thunderstorms upsetting, sleep difficulties, explosive temper and nervousness and last worked in 1980 as a carpenter. On examination, the veteran, who was 41 years old, was neatly dressed and correctly oriented. He denied hallunciations. The examiner diagnosed PTSD and commented that the veteran's social adjustment was moderately impaired and his vocational adjustment was severely impaired. In June 1990, the veteran appealed the RO's action and contended that his service-connected PTSD had worsened. According to a March 1991 VA psychiatric examination report, the veteran used pressured speech to describe flashbacks and nightly nightmares, but denied delusions. The diagnostic impression was PTSD, marital discord and subsequent alcohol abuse. The veteran was married for the first time in 1972, it lasted two and a half years and he had two children from the marriage. He unsuccessfully sought custody of those children, but saw them regularly after the divorce. The veteran remarried, had three children and, in November 1990, separated from his second wife. The veteran described sleep difficulties, occasionally poor appetite, said he quit drinking alcohol in November 1990 and also quit using drugs, namely marijuana. He started going to church. On examination, the veteran was cooperative with his beard shaved and casually dressed. He was scared, afraid, anxious and nervous with depressed affect. The veteran denied current suicide impulse, but had suicide impulse in the past. He had guilt feelings of survival and felt hopeless and worthless. The veteran denied hallucinations. PTSD was diagnosed. The examiner said the veteran's social adjustment was moderately impaired and his vocational adjustment was severely impaired. In October 1992 and August 1997 statements, Paul Esser, Mdiv., a readjustment counseling specialist at a Vet Center, said he counseled the veteran for issues involving combat and financial stress, marital problems, unemployment, stress reactions to thunderstorms and intermittent social withdrawal and isolation. In a February 1993 statement, Jeffrey W. Shurtz, Ph.D., said he treated the veteran since December 1992. The veteran was diagnosed with PTSD and involved in a tumultuous custody battle with his ex-wife that triggered symptoms of PTSD. The manifest symptoms of the veteran's PTSD were alcohol dependency, currently in recovery after VA hospitalization, increased arousal, including intrusive anxiety, insomnia and hypervigilance, boundary confusion reflected by a difficulty distinguishing between the intensity of the combat he endured and frustration of his custody fight and nightmare anxiety, caused by recurrent dramas of combat. According to a December 1992 VA PTSD examination report, the veteran complained of recurrent nightmares, intrusive thoughts, recurring feelings of combat trauma, increased anxiety around anniversary days and hypervigilance and did not see a psychiatrist or currently take medication. The veteran lived alone and cooked, shopped and washed his clothing. His explosive temper made it difficult for him to relate to women. He quit drinking in November 1990, but approximately five weeks ago had one can of beer. The veteran quit using marijuana in 1990 and said he no longer went to church, as he did not like the crowd. On examination, the veteran was cooperative and casually dressed. His personal hygiene was satisfactory. He was anxious and depressed with appropriate affect. His clothes were somewhat dirty and grooming needed improvement. He denied auditory or visual hallucinations and paranoia and was oriented. PTSD was diagnosed with moderate social and severe occupational impairment. VA hospitalized the veteran from March to April 1993 for treatment of PTSD. Adjustment disorder with depressed mood was also diagnosed. At admission, he complained of anger and frustration regarding a custody battle with is wife. The veteran's Global Assessment of Functioning (GAF) score at admission was 45 and at discharge was 55. In April 1993, the RO granted a 30 percent evaluation for the veteran's service-connected PTSD, effective from August 1991, following his period of hospitalization from June to July 1991. At his October 1993 personal hearing at the RO, the veteran testified that he had not received outpatient psychiatric treatment since 1991 or 1992, did not currently take prescribed medication and none was prescribed. He participated in group counseling at the Vet Center. His PTSD symptomatology included intrusive thoughts of combat situations, particularly during a thunderstorm, preventing his children from leaving home during a storm and social isolation, According to an October 1996 VA PTSD examination report, the veteran was alert, well developed and well nourished, with fair general health, marginal personal hygiene and somewhat soiled clothing. He reported sleep difficulty with a recurrent dream of a big flash and was upset by custody issues that, the examiner noted, occurred frequently in the claims file. The veteran had not attempted suicide but said he was angry at the world, angered easily and got into frequent verbal fights. He had never experienced auditory hallucinations. The veteran had not been in treatment for approximately two years since VA ended his access to private treatment. He did not take medication. The veteran had problems sleeping and concentrating but was normally oriented. The Axis I diagnosis was amotivational syndrome, PTSD by history and, at Axis II, the diagnoses were substance dependent, explosive, immature and dependent personality traits. A GAF score of 50 was assigned, denoting serious impairment of social and occupational functioning. In the VA examiner's opinion, the veteran's PTSD was a separate entity that had little effect, as compared with the marijuana withdrawal, on his employability. In light of the implementation of new psychiatric rating criteria, the RO requested that in January 1997, the veteran undergo reexamination by the VA examiner who saw him in October 1996. On examination, the veteran was alert and in general good health with fair to poor personal hygiene and wearing soiled clothing. He described a recurrent dream of an assault by fellow soldiers in Vietnam. The veteran said he lied when last examined and indicated that he used beer as a medication, at least three cans daily but had not used marijuana since 1990. He had custody and cared for his three sons who received no support from their mother. In a typical day the veteran sent his sons to school, tended his home, listened to talk shows and fixed dinner for his boys. He had no outside social activities. Objectively, the veteran was emotionally composed and normally oriented. The Axis I diagnosis was PTSD, by history and, at Axis II, the diagnosis was substance dependent, explosive, immature personality traits. A GAF score of 50 was assigned based upon serious symptoms that caused serious impairment in occupational and social functioning. The VA examiner commented that the veteran appeared to indicate that he continued to have signs and symptoms of PTSD. Further, the veteran's description of his daily activities seemed to describe a housekeeper with busy and complex management of his children and improving the house. The amotivational syndrome diagnosis was removed in view of the report of the veteran's current activities in home. At his August 1997 personal hearing, the veteran's eldest son testified that the veteran treated his sons with regimented behavior. The son described the veteran as explosive and physically confrontational, particularly about issues involving his sons or Vietnam and observed the veteran's sleep difficulties. The veteran testified to last receiving outpatient treatment in 1992 when he last saw Dr. Shurtz. The veteran had not worked since 1980, had no social life due to his mistrust of people and experienced physical confrontations with others. He had recurrent nightmares, self-medicated with alcohol and drank as much beer as possible to avoid thinking about Vietnam. The beer put him to sleep but did not help him sleep. VA hospitalized the veteran in September 1997 with complaints of increased rage and hate, since his children were removed by social services earlier in the month and placed in foster care. He described his children as his purpose in life. The veteran reported alcohol abuse that averaged forty ounces approximately twice a week. With alcohol, there were increased problems with anger that led to verbal explosions with his girlfriend and physical damage to the household. He reported some blackouts but denied seizures or delirium tremens. His last drink was two days prior to admission. At admission, the veteran was well dressed and groomed, attentive and answered questions appropriately. His mood was depressed and anxious with congruent affect, speech normal and there was no psychomotor agitation. He was alert and oriented with fair to good judgment and had no suicidal or homicidal ideations or delusions. Memory was intact. He had a negative urine drug screen at admission. Treatment included alcohol detoxification with medication and group and individual therapy. Depakote was prescribed at discharge. Final diagnoses were PTSD and alcohol dependence and a GAF score of 40 to 50 was assigned. In November 1997, the veteran underwent VA PTSD examination and reported his recent VA hospitalization. After his recent VA hospitalization, the veteran denied alcohol or drug use. He described sleep difficulty problems and social isolation and said he had few friends or outside interests. He denied new medical problems or medications and had no overall change in his functioning compared to one year earlier. The veteran admitted there was a decrement to his functioning earlier this year that led to his sons being removed from the home. Objectively, the veteran appeared to be somewhat unkempt but alert and cooperative. His face was unshaven and he was somewhat malodorous. His speech was of normal form and rate with appropriate affect and mood. The veteran denied auditory or visual hallunciations, except for flashback and nightmare, noted above. There was no evidence of thought disorder or psychosis. His insight was fair with no major cognitive deficits. The Axis I diagnoses were PTSD and history of alcohol abuse, in remission. A GAF score of 50 was assigned that, the VA examiner commented, indicated that the veteran experienced serious problems of PTSD. The VA doctor said the GAF score was based on the veteran's PTSD diagnosis, as it appeared to seriously impair his current ability to function. VA hospitalized the veteran from December 1997 to January 1998 due to feelings of guilt, anger and hostility and increased anxiety after a family altercation. The veteran drank three 40-ounce bottles of beer and had a fight with his sons. He took the two younger sons out of the house, that was against a court order as he was only supposed to have visitation with his sons when accompanied by another person. His niece, who was his sons' guardian, called social services about his action. The veteran admitted his actions were violent, but he had no suicidal or homicidal ideations. He had constant nightmares and flashbacks of Vietnam. The veteran said he was sober after his last VA hospital discharge at the end of September, but in mid November started to binge drink, consuming two or three forty ounce bottles of beer every two or three days. That started about the same time he ran out of Depakote, secondary to his failure to follow up. The veteran did not believe his drinking was a problem, but admitted to blackouts and said alcohol was involved in his most recent altercation with his sons. He used beer to self-medicate and drank until he was unable to feel his anger and despair. He had attended Alcohol Anonymous in the past. When examined at admission, the record indicates that the veteran was hospitalized after having a physical fight with his sons, but did not find this to be a problem. He acknowledged that he needed help but would not state that any of the problems he had were his own fault and had a tendency to blame others. While hospitalized, he was placed on medication and received individual and group therapy. His children were placed in foster care and he wanted to get them back However, when he was told he needed help with his alcohol problem to get his children back, the veteran continued to downplay the role of alcohol in his life and said it was his PTSD that caused the rage that created his family conflicts. While hospitalized, the veteran made many trips to his home out of concern for his sons. Upon each return from passes to home, the veteran received a Breathalyzer and urine drug screen that were negative. He frequently requested to be started on Antabuse to help stop his drinking after discharge but was advised to bring up that request with outpatient follow up doctors, as he was not going to follow up in the VA system. Discharge diagnoses included alcohol abuse and PTSD and a GAF score of 45 was assigned. In April 1998, the RO assigned a 50 percent disability rating for the veteran's service-connected PTSD, effective from March 1990. VA hospitalized the veteran from January to February 1999 and, according to the discharge summary, the veteran sought treatment for PTSD and substance abuse after release from jail for domestic abuse and not being accepted into a private facility for alcohol treatment. The veteran had much anger and said he was last treated for PTSD in 1992. His last alcohol use was two days earlier when he drank eighty ounces of beer and had been drinking three eighty-ounce beers daily. He was abstinent for approximately one month prior to his December 1998 relapse and his last rehabilitation program was in October 1997. When admitted, the veteran was anxious, alert and oriented with constricted affect, clear speech, poor impulse control, mood swings and was coherent. He had racing thoughts but no suicidal or homicidal ideation and denied visual or auditory hallucinations. He had flashbacks and nightmares and poor sleep and expressed some paranoia and phobic reaction to thunder. While hospitalized, the veteran participated in group therapy, including anger management and alcohol and narcotics anonymous. He was accepted and transferred into a PTSD track program. Discharge diagnoses included continuous alcohol dependency, PTSD by history and impulse control disorder. GAF scores of 45 (apparently at admission) and 65 (apparently at discharge) were assigned. The veteran entered the VA PTSD track program in February 1999. When initially admitted, the record indicates it was unclear that he met the criteria for PTSD. He complained of vague nightmares that appeared unrelated to war events. His main problems seemed to be alcohol dependence and some characterological features of antisocial personality disorder. The veteran received alcohol dependence treatment previously but appeared to need more prolonged treatment. He had also been treated for PTSD at another VA medical center. At admission, the veteran appeared anxious and preoccupied with many physical complaints. He had a range of affect and a euthymic mood, complained of difficulty with anger control and apparently had legal charges associated with that. He had limited insight and sense of responsibility and denied homicidal or suicidal ideations. While hospitalized, the veteran received individual and group therapy. He described auditory hallucinations while asleep but not when awake. He described side effects from some prescribed medications and said he was barred from returning home due to legal charges. He was discharged with a one-month supply of prescribed medication. Final diagnoses included PTSD and alcohol dependence, continuous. The veteran's GAF score at admission and discharge was 45. A March 1999 Addendum to the February 1999 VA hospital discharge summary recounts the veteran's alleged stressors in service. When initially admitted to the Specialized Inpatient PTSD program, the veteran suffered from alcohol abuse, anger and irritability, nightmares, flashbacks hypervigilance, intrusive thoughts, social isolation, sleep disturbances, problems with authority figures, fear of thunderstorms and legal problems. He appeared anxious and depressed but denied having thoughts of wanting to harm himself or others. Psychological test results indicated that the veteran exaggerated his symptoms, but other results revealed that he experienced symptoms of avoidance and intrusive recollections of experiences in Vietnam. His hospital treatment involved group therapy, physical conditioning, stress management, sleep enhancement, anger management, and substance awareness and individual psychotherapy sessions. In individual therapy the veteran was concerned about losing his children, described a long history of substance abuse but lacked insight into the role substance abuse had in his legal and custody programs. The veteran had a tendency to blame his problems on situations and other people, rather than seeing the role he played in some of his problems. The veteran was also concerned about possibly having to go to jail. He had been recently arrested for domestic violence, assault, driving under the influence, resisting arrest and theft of a vehicle. Axis I diagnoses were PTSD, alcohol dependence, depressive disorder, not otherwise specified, history of cannabis abuse unspecified and isolative phobias. A current GAF score of 50 was assigned. The veteran underwent VA examination for mental disorders in May 1999 and described being arrested in August 1998 in Florida for driving under the influence. He was involved in an auto accident while driving and knocked unconscious. He was incarcerated for five days. In December 1998, the veteran was arrested again for another driving under the influence and resisting arrest and incarcerated for five days. He was also faced with a pending legal incident in which he was charged with domestic violence against his son in January of 1999. Details were sketchy and the veteran indicated that the charge against him was retaliatory after an altercation with his son and a girlfriend. He was not currently having custody problems regarding his children. The veteran's longest period of sobriety was for about one year, he denied substance abuse rehabilitation treatment or any outpatient substance abuse treatment recently. He described his prior psychiatric hospitalizations, most recently in March 1999 after participating in a five-week program for anxiety and PTSD. He currently took Depakote, Prozac and a sleeping medication and was not followed by a psychiatrist. The veteran complained of depression associated with his children's recent trouble and denied current suicidal or homicidal ideations. He had problems with memory, concentration, impatience, and irritability, fear loss of control, sleep problems and decreased appetite, with a ten-pound weight loss in the past two months. The veteran had an unusual fear of thunderstorms, had mood swings and preferred to be alone. He was generally vigilant, felt persecuted by the system and mistrusted everyone because those whom he got close to invariably disappointed him. He denied auditory or visual hallucinations. One examination, the veteran was oriented and had poor concentration. His typical day involved arising, drinking coffee and getting his children ready for school. While they were gone, he performed housecleaning chores, including sweeping and mopping the floors and doing some laundry in his bathtub since he did not have a washing machine. He watched television, mowed his lawn, grocery shopped and managed his finances. He had no other hobbies. Objectively, the veteran was cooperative, somewhat untidy in his appearance and smelled of heavy tobacco. During the evaluation he had a somewhat perplexed and tense facial expression. His speech was spontaneous and progressed in formal fashion. Mood was normal, but he displayed some inappropriate laughter at times when discussing certain aspects of his history. His perception appeared normal. He was oriented to time, place and person. His memory appeared generally unimpaired. His general fund of knowledge appeared somewhat limited and concrete. His insight was minimal and his operational judgment appeared poor. Suicidal risk appeared low at that time. The VA examiner found that, diagnostically, the veteran's presentation most clearly resembled an anxiety- based disorder. The veteran appeared competent to handle his affairs. Industrial adaptability seemed guarded. The Axis I diagnosis was PTSD, chronic and a GAF of 55 was assigned Analysis Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities, found in 38 C.F.R. Part 4 (1999). The Board attempts to determine the extent to which the veteran's service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, and the assigned rating is based, as far as practicable, upon the average impairment of earning capacity in civil occupations. 38 U.S.C.A. § 1155; 38 C.F.R. §§ 4.1, 4.10 (1999). Where 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 (1999). Although the evaluation of a service-connected disability requires a review of the veteran's medical history with regard to that disorder, the primary concern in a claim for an increased evaluation for service-connected disability is the present level of disability. 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, the regulations do not give past medical reports precedence over the current findings. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Effective November 7, 1996, VA amended several sections of the Rating Schedule in order to update the portion of the Rating Schedule, pertaining to mental disorders to ensure that current medical terminology and unambiguous criteria are used. 38 C.F.R. §§ 4.125 to 4.130 (1999). The changes included redesignation of § 4.132 as § 4.130 and the revision of the newly redesignated § 4.130. Also, the general rating formula for mental disorders was replaced with different criteria. And, in some instances the nomenclature employed in the diagnosis of mental disorders was changed to conform with the Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition, of the American Psychiatric Association (DSM-IV), replacing DSM-III-R. The Board notes that the RO evaluated the veteran's claim under the old regulations in making its rating decision dated April 1990. The statement of the case, dated July 1990, and the May and October 1991 and March 1994 supplemental statements of the case, referred the old regulations. In the February 1997, September 1998 and August 1999 supplemental statements of the case, the RO evaluated the veteran's claim under new regulations. The veteran was afforded an opportunity to comment on the RO's action and did not choose to do so. Accordingly, there is no prejudice to the veteran under Bernard v. Brown, 4 Vet. App. 384 (1993). Under the old, pre-November 1996 criteria, a 50 percent rating under 38 C.F.R. § 4.132, Diagnostic Code 9411 (1996) was assigned when the ability to establish or maintain effective or favorable relationships with people was considerably impaired. Id. By reason of psychoneurotic symptoms, the reliability, flexibility and efficiency levels were so reduced as to result in considerable industrial impairment. Id. A 70 percent evaluation for PTSD was warranted where the ability to establish and maintain effective or favorable relationships with people was severely impaired, and the psychoneurotic symptoms were of such severity and persistence that there was severe impairment in the ability to obtain or retain employment. Id. A 100 percent evaluation was warranted (1) when the attitudes of all contacts except the most intimate were so adversely affected as to result in virtual isolation in the community; (2) where there were 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) where the veteran was demonstrably unable to obtain or retain employment. Id. Under the revised schedular criteria, effective November 7, 1996, Diagnostic Code 9411, 38 C.F.R. § 4.130, for PTSD, is evaluated under the general rating formula used to rate psychiatric disabilities other than eating disorders. 38 C.F.R. § 4.130 (1999). A 50 percent rating is assigned when there is 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 maintain effective work and social relationships. Id. A 70 percent rating is warranted when there is occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, 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); and the inability to establish and maintain effective relationships. Id. A 100 percent rating is warranted if there is total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; gross 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. Id. The U.S. Court of Appeals for Veterans Claims (known as the U.S. Court of Veterans Appeals prior to March 1, 1999) 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 unless Congress provided otherwise. Karnas v. Derwinski, 1 Vet. App. 308, 313 (1991). However, pursuant to Rhodan v. West, 12 Vet. App. 55 (1998), the old rating criteria is for application previous to the effective date of the change and both the old and new rating criteria are for consideration as of the effective date of the regulatory change, November 7, 1996. After considering all the evidence of record, it is the judgment of the Board that the schedular criteria for a 70 percent rating are met as the veteran's service-connected PTSD has resulted in severe, but not total, occupational and social impairment. In October 1996, a VA examiner concluded that the veteran's PTSD had little effect, as compared with marijuana withdrawal, on his employability. Although in May 1999, a VA examiner said the veteran's industrial adaptability was guarded, the physician also diagnosed alcohol dependence. When examined by VA in May 1999, the veteran was oriented, with normal mood and perception. Persistent delusions, gross inappropriate behavior or other symptoms such as to warrant a 100 percent evaluation under the new criteria are not demonstrated. Similarly, as for the old rating criteria for a 100 percent evaluation, neither virtual isolation, totally incapacitating psychoneurotic episodes, nor a demonstrable inability to work due to service-connected PTSD, are shown. Accordingly, a 70 percent evaluation for the service-connected PTSD is most appropriate at this time. The benefit of the doubt has been resolved in the veteran's favor to this extent. 38 U.S.C.A. §§ 1155, 5107; 38 C.F.R. §§ 4.7, 4.132, Diagnostic Code 9411, prior to November 7, 1996; 38 C.F.R. §§ 4.125, 4.130, Diagnostic Code 9411, effective November 7, 1996. The Board notes that a Social Security Administration (SSA) decision found the veteran suffering from a PTSD and held him to be disabled since November 1981. While the Board recognizes the disabling nature of the veteran's PTSD, the SSA decision is not considered sufficient to overcome the objective evidence of record. ORDER A 70 rating for PTSD is granted, subject to the laws and regulations governing the payment of monetary benefits. ROBERT E. SULLIVAN Member, Board of Veterans' Appeals