Citation Nr: 0005503 Decision Date: 02/29/00 Archive Date: 03/07/00 DOCKET NO. 94 - 46 881A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Cleveland, Ohio THE ISSUES Entitlement to an effective date prior to June 5, 1998 for the assignment of a rating in excess of 50 percent for post- traumatic stress disorder, to include on an extraschedular basis. Entitlement to a total disability rating based on unemployability due to service-connected disability during the period from May 31, 1991 to June 5, 1998. REPRESENTATION Appellant represented by: R. Edward Bates, Attorney ATTORNEY FOR THE BOARD Frank L. Christian, Counsel INTRODUCTION The veteran served on active duty from June 1967 to April 1970, including service in the Republic of Vietnam. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision of April 1992 by the Department of Veterans Affairs (VA) Regional Office (RO) in Cleveland, Ohio, which denied entitlement to a rating in excess of 50 percent for post-traumatic stress disorder (PTSD). Thereafter, the veteran appealed a rating decision of November 1994 which denied entitlement to a total disability rating based on unemployability due to service- connected disability and which determined that clear and unmistakable error (CUE) had not been committed in certain prior rating decisions in failing to infer and adjudicate the issue of entitlement to a total disability rating based on unemployability due to service-connected disability. A Board decision of April 29, 1998, denied the appeal brought upon a claim of clear and unmistakable error (CUE) in certain rating decisions prior to the unappealed Board decision of April 1991 and in the rating decisions of April 1992 and January 1994. The appellant was given appropriate written notice of those adverse determinations and of his right to appeal those decisions to the United States Court of Appeals for Veterans Claims (Court). In addition, the Board decision of April 29, 1998, remanded the issues of entitlement to a rating in excess of 50 percent for PTSD and entitlement to a total disability rating based on unemployability due to service-connected disability to the RO for further development of the evidence, to include a VA psychiatric evaluation and medical opinion. The RO was further directed to adjudicate those claims initially raised by the appellant's attorney in his Notice of Disagreement received in June 1994, including claims of entitlement to a rating in excess of 50 percent for PTSD on an extraschedular basis under the provisions of 38 C.F.R. § 3.321(b)(1) and of entitlement to service connection for anxiety, substance abuse, and a dysthymic disorder as secondary to his service- connected PTSD, to include consideration under the principles enunciated by the Court in Allen v. Brown, 7 Vet. App. 439, 448 (1995). Thereafter, the RO was directed to readjudicate the issues of a rating in excess of 50 percent for PTSD and of entitlement to a total disability rating based on unemployability due to service-connected PTSD in light of the determinations reached with respect to the pending and unadjudicated claims of entitlement to an extraschedular evaluation for PTSD under the provisions of 38 C.F.R. § 3.321(b)(1) and the claim for entitlement to service connection for anxiety, substance abuse, and a dysthymic disorder as secondary to service-connected PTSD. While this appeal was thus in Remand status, a rating decision of March 1999 granted a schedular evaluation of 100 percent for PTSD, effective June 5, 1998; determined that such total schedular disability was permanent in nature; and granted entitlement to Dependents' Educational Benefits under the provisions of 38 U.S.C.A., Chapter 35 (1999). That action constitutes a total grant of the appeal for a rating in excess of 50 percent for PTSD as of the effective date of that grant and subsequently. In addition, the March 1999 rating action rendered moot the claim for a total rating based on unemployability due to service-connected disability as of June 5, 1998, under the authority of Vettese v. Brown, 7 Vet. App. 31, 34-35 (1994) and VAOPGCPREC 6-99. However, the Board concludes that the claim of entitlement to a total disability rating based on unemployability due to service-connected disability from May 31, 1991, to June 5, 1998, remains in appellate status before the Board. The rating decision of March 1999 further denied an inferred claim of entitlement to special monthly compensation based upon the need for aid and attendance or by reason of being housebound under the provisions of 38 U.S.C.A. §§ 1114(l) and (s), and denied service connection for anxiety and a dysthymic disorder as secondary to service-connected PTSD, and denied entitlement to service connection for alcoholism and a substance abuse disorder as secondary to service- connected PTSD. Although the appellant was notified of those determinations and of his right to appeal by RO letter of April 12, 1999, a May 1999 letter from his attorney stated that "as the RO has recently granted [the appellant] 100 percent schedular, [the appellant] disputes only the effective date." The Board finds that such statement, together with the absence of a Notice of Disagreement as to the other issues denied in the March 1999 rating decision, and the additional written statement that the appellant specifically waives the right to have the [RO] prepare any subsequent Supplemental Statement of the Case(s), Rating Decision(s), Decisional Officer Decision(s), Compensation and Pension Examinations, and any other action by this agency prior to the transfer of the veteran's claims folder to the BVA, constitutes a withdrawal or abandonment of the claims of entitlement to special monthly compensation based upon the need for aid and attendance or by reason of being housebound under the provisions of 38 U.S.C.A. §§ 1114(l) or (s); the claim of entitlement to service connection for anxiety and a dysthymic disorder as secondary to service-connected PTSD; and the claim of entitlement to service connection for alcoholism and substance abuse disorder as secondary to service-connected PTSD. Accordingly, the Board will not address those issues. The Board limits its consideration herein to the issues stated on the title page of this decision. FINDINGS OF FACT 1. The appellant's claim for a rating in excess of 50 percent for PTSD, received at the RO on May 31, 1991, is plausible because the appellant asserted that his service- connected disability had increased in severity and submitted evidence in support of that claim. 2. The appellant's claim for a total disability rating based on unemployability due to service-connected disability (VA Form 21-8940), received at the RO on March 7, 1994 is plausible because the appellant asserted that his service- connected mental disability had increased in severity and had rendered him incapable of securing and following a substantially gainful occupation. 3. All relevant evidence necessary for an equitable disposition of the instant appeal has been obtained by the RO. 4. A rating decision of March 1999 granted a schedular 100 percent disability rating for PTSD, conceded permanence, and granted Dependents' Educational Assistance benefits (Chapter 35), effective June 5, 1998, the date of the last VA examination of the appellant, thereby granting the benefit sought on appeal and rendering the claim for a total disability rating based on unemployability moot as of that date. 5. Competent medical evidence, dated in December 1991, and in May and November 1993 and subsequently, shows that the veteran's PTSD and other diagnosed psychiatric disabilities were productive of no more than moderate impairment of social, occupational, or school functioning; competent and credible medical evidence, dated in November 1993, states that the veteran's psychiatric disability appears to be mostly due to his severe personality disorder. 6. Competent and credible medical evidence dated prior to and in March 1997 shows that the veteran was found on VA psychological examination to be competent and not unemployable; that the veteran was regularly attending college classes and interacting with students and faculty on a regular basis; and that the Axis IV psychosocial stressors attributed to the veteran on VA psychological and psychiatric examinations in March 1997 did not involve inservice trauma or PTSD symptomatology. 7. The medical and other evidence of record does not establish that, as a sole result of the veteran's service- connected PTSD, his ability to establish or maintain effective or favorable relationships with people was more than considerably impaired or that reliability, flexibility and efficiency levels were so reduced by reason of psychoneurotic symptoms as to result in more than considerable industrial impairment such as to warrant assignment of a rating in excess of 50 percent at any time prior to June 5, 1998, under the criteria in effect prior to November 7, 1996. 8. The medical and other evidence of record does not establish that veteran's service-connected PTSD, standing alone, was productive of more than 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 such as to warrant assignment of a rating in excess of 50 percent at any time prior to June 5, 1998 under the criteria in effect on and after November 7, 1996. 9. The veteran was not assigned a 70 percent evaluation for his service-connected PTSD, nor was he shown to be unemployable as a result of a mental disorder, prior to November 7, 1996, under the provisions of 38 C.F.R. Part 4, § 4.16(c) (1996). 10. The veteran did not meet the minimum schedular requirements and was not otherwise shown to be unable to secure and maintain substantially gainful employment prior to June 5, 1998, under the provisions of 38 C.F.R. Part 4, § 4.16(a) or(b) (prior to or on and after November 7, 1996). CONCLUSIONS OF LAW 1. The claim for an effective date prior to June 5, 1998, for assignment of a rating in excess of 50 percent for PTSD is well-grounded. 38 U.S.C.A. § 5108 (West 1991 & Supp.1998); Proscelle v. Derwinski, 2 Vet. App. 629 (1992); Drosky v. Brown, 10 Vet. App. 251 (1997). 2. The claim for a total disability rating based on unemployability due to service-connected disability between May 31, 1991 and June 5, 1998, is well grounded. 38 U.S.C.A. § 5108 (West 1991 & Supp.1998); Proscelle v. Derwinski, 2 Vet. App. 629 (1992); Drosky v. Brown, 10 Vet. App. 251 (1997); Suttmann v. Brown, 5 Vet. App. 127, 136 (1993); 3. The criteria for a rating in excess of 50 percent for PTSD were not met prior to June 5, 1998, under the criteria in effect prior to or on and after November 7, 1996, nor was an extraschedular rating warranted for PTSD during that period. 38 U.S.C.A. §§ 1155, 5107(a) (West 1991); 38 C.F.R. 3.321(b)(1), Part 4, §§ 4.7, 4.125, 4.130, 4.132, Diagnostic Code 9411 (prior to or on and after November 7, 1996). 3. The veteran was not assigned a rating in excess of 50 percent for a mental disorder or other service-connected disability, nor was he unable to secure or follow a substantially gainful occupation as a result of service- connected disabilities during the period from May 31, 1991, to June 5, 1998. 38 U.S.C.A. § 1155, 5107(a) (West 1991); 38 C.F.R. Part 4, §§ 4.16(a),(b),(c) (prior to or on and after November 7, 1996.) REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Board finds that the appellant's claims are plausible and are thus "well grounded" within the meaning of 38 U.S.C.A. § 5107(a) (West 1991). A claim for an increased or total rating is generally well grounded when the appellant indicates that he has suffered an increase in disability and submits supporting evidence. Proscelle v. Derwinski, 2 Vet. App. 629 (1992); Drosky v. Brown, 10 Vet. App. 251 (1997); Suttmann v. Brown, 5 Vet. App. 127, 136 (1993); Glover v. West, No. 99-7015 (Fed.Cir.) August 2, 1999. We further find that the facts relevant to the issues on appeal have been properly developed, and that the statutory obligation of VA to assist the veteran in the development of his claims has been satisfied. 38 U.S.C.A. § 5107(a)(West 1991). I. Evidentiary and Procedural History A review of the record shows that a Board decision of April 1991 denied entitlement to a rating in excess of 30 percent for PTSD prior to March 9, 1990, and denied a rating in excess of 50 percent for PTSD thereafter. That decision was not appealed to the United States Court of Appeals for Veterans Claims (Court) within the statutory period and became final. In a Statement in Support of Claim (VA Form 21-4138), received at the RO on May 31, 1991, the veteran reopened his claim for a rating in excess of 50 percent for PTSD, asserting that his condition had worsened; that he was currently being counseled at the Cleveland VetCenter; and that he wanted a VA disability compensation examination. A June 1991 letter from a VA Vocational Rehabilitation Specialist stated that the veteran had reentered his pre- Nursing program at Cuyahoga Community College in April 1989; that since that time his academic record had been very good and he had worked hard to achieve his grades; that the veteran has related to him PTSD symptoms, financial stresses and everyday pressures while attending classes; that he doubted that the veteran's current stress-related problems would allow him to work prior to completing his nursing program; and that he hoped that the veteran's motivation to assist others would eventually overcome his stress-related problems. A September 1991 letter from a social worker at the Cleveland VetCenter cited the veterans personal, social, marital, educational, military and occupational history; indicated that he had been married for 20 years and had five children; noted that he was doing "quite well" in a nursing program at Case Western Reserve University; acknowledged that on first contact the veteran appeared to have no psychological disorder, and that further assessment revealed no more than considerable social and occupational impairment; noted that the cessation of his frequent hospitalizations in March 1990 suggested improvement in his condition; and expressed the opinion that he would benefit from further evaluation of his 50 percent rating. He noted that the veteran had retired in 1985; that he currently received retirement benefits from the City of Cleveland; and that the veteran attributed his ongoing alcohol abuse as "mostly to sleep" but also to decrease the frequent intrusive memories of his Vietnam experience. A report of VA psychiatric examination, conducted in December 1991, recounted the veteran's current complaints, as well as his personal, family, medical, military, and vocational history. It was noted that the veteran last worked as a maintenance man in 1985, and reported that he stopped working due to stress. The veteran stated that he had been hospitalized on five occasions for PTSD; that he was hospitalized for alcohol abuse in 1981 and in 1985; and that he was currently being seen for PTSD at the VAMC Brecksville. Mental status examination revealed that he had a slightly neglected appearance, showed overt depression with sad facial expressions, and exhibited a sense of a foreshortened future, anxiety with an exaggerated startle response, and tension when questioned about his Vietnam experiences. His speech was logical and goal-directed, he established good rapport, he was functioning fairly well intellectually, his recent and remote memory were intact, and there was no evidence of delusions, hallucinations, or gross distortion of insight and judgment. The diagnoses included Axis I: PTSD; alcohol abuse, by history, in remission; marijuana abuse, by history, in remission; Axis II: None; Axis IV: Stress, severe (4); and Axis V: moderate impairment of psychosocial functioning; Global Assessment of Functioning (GAF) score 60, indicative of moderate symptoms or moderate difficulty in social, occupational or school functioning. A rating decision of January 1992 proposed to reduce the evaluation for the veteran's PTSD from 50 percent to 30 percent disabling, and the veteran was notified of the proposed action. A January 1992 letter from a social worker at the Cleveland VetCenter stated that, while his prior letter in September 1991 indicated that the veteran was improving, he had made a GPA of 1.5 in his last school semester. He attributed that performance to the veteran's increasing symptomatology and medication dosages, as well as family pressure, and called attention to decreased social and industrial functioning as sufficient to warrant consideration of an increased disability rating. A rating decision of April 1992 determined that the proposed reduction in rating for the veteran's PTSD was not warranted, and confirmed and continued his 50 percent rating for PTSD. The veteran was notified in writing of that determination and of his right to appeal. In December 1992, he filed a timely Notice of Disagreement with the denial of his claim for a rating in excess of 50 percent for PTSD, and a Statement of the Case was issued in February 1993. Records contained in the veteran's Vocational Rehabilitation & Education (Chapter 31) folder show that the veteran began attending a Registered Nurse degree program at Cuyahoga Community College (CCC) in April 1989; that he attended school regularly until August 1991, when he entered the same program at Case Western Reserve University; and that in July 1992, his case was reviewed because of his request for an extension of Chapter 31 Vocational Rehabilitation & Educational training benefits. At that time, it was noted that the veteran would have used all but 1.5 months of Chapter 31 training in August 1992; that he had maintained a GPA in excess of 2.5 during the Spring semester after some adjustment problems in the Fall semester; that the veteran's nursing program was necessary to overcome his employment handicap; that he had demonstrated that he could handle his training and practicum; that he was scheduled to complete his program in June 1995; and that he would be employed at the Cleveland Clinic for two years after his graduation. In January 1993, the veteran submitted a Report of Attending Physician, completed by a physician at the VA Center for Stress Recovery in February 1986, and directed to the Public Employees Retirement System of Ohio (PERS). That document diagnosed PTSD and indicated that the veteran exhibited, in varying degrees and at varying times, the symptoms and signs of his mental disorder; that he had been advised not to return to work until his symptoms had diminished and his functioning had improved; and that in his opinion the veteran was permanently incapacitated for duty and should be retired. That report did not address the veteran's 18-year history of alcoholism or his prior hospitalizations for detoxification and rehabilitation at the VAMC, Brecksville, in 1981 and 1985. In addition, the veteran submitted a May 1987 Statement of Disability by a VA psychologist, who expressed the opinion that the veteran was permanently disabled for work due to PTSD symptomatology, and that such was likely to be a life- long chronic condition. A January 1992 letter from a VA physician stated that the veteran was being treated for PTSD at the VetCenter and at the VA mental health clinic. A cover letter from the veteran's service organization representative, dated in January 1993, indicated that the foregoing evidence [dated in February 1986, May 1987, and January 1992] was submitted in support of the veteran's claim for increased service-connected disability benefits. In his Substantive Appeal (VA Form 9), received in March 1993, the veteran requested a personal hearing at the RO and a travel board hearing. He further stated that his previous VA psychiatric examination was too short and was thus inadequate; that he had to discontinue his nursing program due to poor concentration; that he was continuing to receive treatment at the VetCenter and at the VA mental health clinic; and that he was entitled to a rating in excess of 50 percent for PTSD. VA outpatient clinic records dated in July 1992 show that the veteran was seen seeking a medication refill and complaining of increased alcohol intake and missing school classes. The clinical impression was PTSD and alcohol abuse (binges), and it was recommended that the veteran stop drinking. His request for sleeping medications was declined until his psychiatric medication regime was reinstituted. He was again seen in November 1992, stating that he had dropped out of school, allegedly secondary to PTSD. It was noted that he was followed at the VetCenter. He complained of increased symptomatology, and was given medication refills. An undated letter from a social worker at the Cleveland VetCenter to Case Western Reserve University asked that the veteran be granted medical leave due to an exacerbation of PTSD symptoms. A June 1992 letter from Case Western Reserve University notified the veteran that, as a result of his performance during the Spring semester 1992, he had been continued on academic probation for the Fall semester 1992. Other documents showed that the veteran had withdrawn from nursing classes in October and November 1992 based on "illness". Letters to the veteran from the Agent Orange Administration, dated in July and August 1992, established an earlier disability onset date of December 1985, based upon certification of his date of state government retirement, for payment to the veteran of total disability benefits under the Agent Orange Veteran Payment Program Fund. The veteran resumed classes from February through June 1993 at Cuyahoga Community College under the provisions of the Vocational Rehabilitation & Education (Chapter 31) program. A report of VA psychological evaluation, conducted in May 1993, cited the veteran's report of stressors, symptoms and treatment history, and noted that he had dropped out of "medical school" in November 1992, claiming that his initial attempts at clinical practice had proved too stressful. He further related that his marital relationship was completely alienated, that he was isolated, and that he had not worked since 1987. He underwent a battery of psychological testing, including the MMPI, the Beck Depression Inventory, the Mississippi Scale for Combat Stress, the Impact of Event Scale, and a clinical interview. It was reported that the test results were exaggerated, but were consistent with a history of treatment failure and his current presentation, and reflected a sense of depression and a display of distress. His degree of disability was estimated as severe, although he remained competent to manage his funds. The diagnoses included Axis I: chronic PTSD; alcohol abuse by history; Axis II: Antisocial features; Axis IV: Extreme; and Axis V: GAF score of 45, indicative of serious symptoms or any serious impairment in social, occupational or school functioning. A report of VA psychiatric examination, conducted in May 1993, cited a history of stressors, symptoms, unemployment since 1985, and [interrupted] school attendance, noting the veteran's statement that he quit school because he "could not handle it." His current complaints included flashbacks, nightmares, concentration problems, depression, avoidant behaviors, easy irritation, intolerance, and frequent tearfulness. Mental status examination revealed that he was cooperative, alert and well-oriented, with coherent and relevant speech. His affect was labile and his mood tense, and he recounted past episodes of suicidal ideation and behaviors. His cognition and memory were preserved, and calculation was well done. Abstract thinking, insight and judgment were fair, and he was competent. The diagnoses included Axis I: PTSD; History of substance abuse, alcohol and drugs; Axis II: Antisocial personality disorder (brought gun onto the premises); Axis IV: Moderate - marital separation - unable to hold a job; and Axis V: GAF score of 60; moderate difficulty in social and occupational functioning. A May 1993 letter to the veteran's representative from a social worker at the Cleveland VetCenter stated that the veteran continued to manifest PTSD symptomatology with fluctuating levels of intensity based upon his involvement in treatment; that his treatment contact had been sporadic due, in part, to intolerance of working on unresolved traumatic issues; and that he appeared to have deteriorated since March 1992. He further stated that even with regular treatment and medication, the veteran presented a more chronic level of PTSD than since 1980; that his school program provided him an opportunity to avoid his PTSD symptoms, his spouse, and occasionally his children; and that he might reach a level of decreased PTSD symptoms and increased social functioning, although his current prognosis was poor. It is noted that the corresponding social worker had previously reported that he had not been involved with the veteran's treatment prior to March 1989. A rating decision of June 1993 confirmed and continued the veteran's 50 percent evaluation for PTSD. A report of VA psychiatric examination, conducted in November 1993, cited the veteran's complaint that VA forced him to retire in 1985 because of his inability to function; that he received Agent Orange benefits because VA told them he was totally disabled; and that he only got 50 percent disability because he is black. He acknowledged a family history that included schizophrenia; that he had been married for 22 years and was "back-and-forth" with his wife; that he saw his military experiences in racial terms; that he acknowledged disciplinary and drug problems during and since service [cocaine, marijuana, speed, heroin]; that he was given retirement from his employment; and that his current medications included Trazodone, Vistaril, and Lorazepam. The examining psychiatrist remarked upon the veteran wearing a black glove on his left hand, which the veteran related he did every November, ostensibly to "remember the way blacks were treated". He asserted that he received treatment for PTSD every week, but had not gone during the current week because he "was not there the last time, I do not always go[,] it depends." He further stated that he only drank when he could not get his medications, which he attributed to the fault of others in not having his medication available. He denied, "not very convincingly", that he used street drugs. He was very angry regarding his disability, which he claimed should be higher, and stated that "the doctor at Wade Park [VA Medical Center] told [him] that blacks are only given 30 percent disability because they are born with stress and they are not given as much disability as whites." The VA psychiatric examiner stated that throughout the examination, it was very obvious that the veteran was obsessively preoccupied with the issue of discrimination of blacks and whites. He noted that, while the record showed a history of PTSD, the current examination revealed a very severe paranoid personality disorder. The veteran was considered competent. The diagnoses included Axis I: PTSD by history; history of alcohol and drug abuse claimed by veteran to be "under control"; Axis II: Paranoid personality, severe; Axis IV: [No entry]; and Axis V: GAF score of 55 to 60, indicative of moderate symptoms or moderate impairment in social, occupational or school functioning. The examining psychiatrist stated that, "[T]he disability mostly appear[s] due to his severe personality disorder." A rating decision of January 1994 confirmed and continued the veteran's 50 percent evaluation for PTSD, the rating board noting that the veteran's personality disorders were not considered disabilities under applicable legislation providing for payment of VA disability compensation benefits. Another Supplemental Statement of the Case was issued. In March 1994, the veteran appointed a private attorney as his representative. On March 7, 1994, he filed VA Form 21- 8940 seeking a total disability rating based on unemployability due to service-connected disability. That document disclosed that the veteran last worked as a maintenance man with a municipal housing authority in November 1985; that he had not attempted to obtain employment since that date; and that he reported no physician's treatment or hospitalizations within the past year. In addition, he filed claims for service connection for a disability without identifying the disability in question; for a rating in excess of 50 percent for PTSD, although that issue was already in appellate status; for an extraschedular evaluation for his service-connected PTSD; for service connection for depression and anxiety as secondary to PTSD; service connection for substance abuse, including alcoholism; for a permanent and total disability rating for pension purposes; and a claim of clear and unmistakable error in certain prior rating decisions. In June 1994, the veteran submitted a Notice of Disagreement purporting to take issue with the rating decision of January 1994 continuing the denial of his claim for a rating in excess of 50 percent for PTSD, a claim which was then in appellate status. In addition, that Notice of Disagreement stated that the veteran sought benefits as set out in his prior claim of March 1990, as supplemented by a subsequent claim submitted in March 1994. The March 1994 filing sought service connection for unstated disabilities; a rating in excess of 50 percent for PTSD, although that issue was already in appellate status; entitlement to an extraschedular evaluation for his service-connected PTSD; service connection for depression and anxiety as secondary to PTSD; service connection for substance abuse, including alcoholism, as secondary to PTSD; and a claim of clear and unmistakable error in prior rating decisions. In addition, it was asserted that the veteran disagreed with "all denials of benefits to which he or she [sic] may be entitled, including those benefits which have not been specifically identified but should reasonably have been inferred by the VA." Further, the veteran was said to claim entitlement to service connection for all such unidentified benefits. It was indicated that, if the veteran was not granted a schedular 100 percent rating and unemployability from December 1985, the veteran requested a Statement of the Case. As of the date of receipt of the Notice of Disagreement in June 1994, the only issue which had been adjudicated, denied, appealed, and placed in proper appellate status was that of a rating in excess of 50 percent for PTSD. The RO regarded that Notice of Disagreement as without effect with respect to pending and unadjudicated issues. In July 1994, the veteran submitted a June 1994 report from a private clinical psychologist who expressed the opinion that the veteran had been unemployable since November 1985. That report indicated that the corresponding psychologist had not clinically interviewed the veteran; had not reviewed the veteran's medical records apart from those selected by his private attorney; made no mention of the veteran's Axis II diagnoses which included severe paranoid personality and antisocial personality disorder; appeared to be unaware of the veteran's extensive period of alcohol and substance abuse and evidence that such abuse was continuing; and failed to weigh the impact of those conditions upon the veteran's employability or to state that such had no impact. A rating decision of November 1994 continued the denial of a rating in excess of 50 percent for PTSD; denied a total disability rating based on individual unemployability due to service-connected disability; and denied any prior clear and unmistakable error in failing to infer the issue of total disability rating based on individual unemployability due to service-connected disability. A Supplemental Statement of the Case was issued addressing the appeal for a rating in excess of 50 percent for PTSD. By RO letter of December 1994, the veteran was informed of the denial of the claim for a total disability rating based on unemployability due to service-connected disability; and of the denial of the claim of clear and unmistakable in certain prior rating decisions concerning the failure to address the issue of total disability rating based on unemployability due to service- connected disability, and was notified of his right to appeal those determinations. In December 1994, the veteran submitted a Substantive Appeal (VA Form 9), with attachments, which purported to perfect the veteran's appeals for a rating in excess of 50 percent for PTSD and for a total rating based on unemployability due to service-connected disability; and of clear and unmistakable error concerning the failure to address the issue of total disability rating based on individual unemployability due to service-connected disability. That document again stated that the veteran disagreed with "all denials of benefits to which he or she [sic] may be entitled, including those benefits which have not been specifically identified but should reasonably have been inferred by the VA." Further, the veteran was said to claim entitlement to service connection for all such unidentified benefits. The RO accepted the VA Form 9 received in December 1994 as a Notice of Disagreement with the November 1994 rating decision denying a total disability rating based on unemployability due to service-connected disability and the denial of clear and unmistakable error in prior rating decisions concerning the failure to address the issue of total disability rating based on unemployability due to service-connected disability. A Supplemental Statement of the Case was issued in March 1995 addressing those issues and the issue of a rating in excess of 50 percent for PTSD. RO requests for outpatient treatment records from the VAMC, Brecksville, subsequent to November 1992 yielded no additional records that had not already been secured. Efforts to obtain records from Cuyahoga Metropolitan Housing Authority (CMHA), the agency which employed the veteran prior to his retirement, and from Public Employees Retirement System of Ohio (PERS), the agency paying retirement benefits to the veteran, were unavailing. The veteran was notified of the difficulty in obtaining those records, and his assistance was solicited. A Supplemental Statement of the Case was issued in June 1995 addressing the three issues in appellate status. A VA Form 21-4192 from CMHA, the veteran's last employer, received in June 1995, stated that the veteran last worked in November 1985; and that he was placed on disability retirement with benefits payable through PERS. A letter from PERS, received in October 1995, included a report of medical examination from a VA physician, dated in April 1986, who indicated that the veteran was presumed to be physically or mentally incapacitated permanently due to chronic severe PTSD, a dysthymic disorder, paranoid [personality] traits, and alcohol abuse, in remission, and should be retired for disability. Another report of medical examination from a VA physician, dated in May 1987, indicated that the veteran was presumed to be physically or mentally incapacitated permanently due to chronic PTSD, a dysthymic disorder, and alcohol abuse, and should be retired for disability. The letter from PERS stated that the documents provided were all the records pertaining to the veteran's retirement. A Supplemental Statement of the Case was issued in March 1996, and a Substantive Appeal ( VA Form 9) was received in March 1996 and accepted as timely by the RO. VA outpatient clinic records dated in March 1996 show that the veteran's father and brother had died; that he had been off his medications for two months; and that he needed medication refills. A December 1996 letter to the veteran from a counseling psychologist in VA's Vocational Rehabilitation & Counseling Division informed him he had been approved to receive Vocational Rehabilitation & Educational (Chapter 31) benefits for a BA in Psychology program at Ursuline College, beginning January 1997 and continuing on a term-to-term basis through August 1998. He was informed that the following schedule would permit him to obtain the 36 hours he needed to graduate within the remaining benefit period available to him: from January 1997 to May 1998 at 3/4 time; from August to December 1998 at 1/2 time; that he will have used 50 weeks at 3/4 time and 23 weeks at 1/2 time; and that his use of Chapter 31 benefits would continue to be monitored. In February 1997, the veteran was awarded Vocational Rehabilitation & Educational (Chapter 31) benefits for a BA in Psychology program at Ursuline College at the 3/4 time rate (9 credit hours), beginning January 1997 and continuing through May 1997. VA outpatient clinic records dated in February 1997 indicate that the veteran had gotten very angry with the reporting physician because he had failed to write a letter that the veteran demanded two years previously when the veteran was not in treatment with him and the physician felt that he could not validly comment on what had taken place. During the interview, the veteran stated that he wanted to see another physician because the reporting physician did not "believe in the diagnosis of PTSD" and that there were racial reasons why he was only getting 30 [sic] percent while white men with PTSD were getting a higher rating. He was referred to the VetCenter for counseling. By RO letter of January 1997, the veteran was asked to identify any private physicians who had treated him for his mental condition, and to complete medical record release authorizations for those physicians. A March 1997 letter from Walter P. Knake, Jr., a private psychologist, indicated that he had seen the veteran since April 1996, and that the veteran had asked that he submit a letter to VA. He stated that the veteran had been assigned a diagnosis of PTSD; that he had been placed on disability from his job; that the veteran continued to experience symptomatology associated with the PTSD diagnosis; that it was the writer's professional opinion that the veteran was unemployable at the present time; that he met the criteria for a 100 percent schedular evaluation for his PTSD; and that his level of psychological functioning, which he defined as his GAF score, was 3.5 [sic]. A report of VA psychological evaluation, conducted in March 1997, noted that the examiner had reviewed the claims folder and previous reports of psychological evaluation and psychiatric examinations, and found the history offered by the veteran to be consistent with his previous reports and the previous diagnoses. The veteran currently lived with his wife and three children, his daughter having recently moved from the house. He recounted being verbally explosive, harsh and given to angry outbursts with his family, and noted recent stressors which included the deaths of his brother and father within two weeks of each other, and his mother having cancer. He stated that he retired because of problems with explosiveness, suspiciousness, and hypervigilance that caused a poor work performance and caused people to fear him. He related classic PTSD symptomatology, indicated that he was seeing a private psychologist approximately once every two weeks, denied using alcohol or street drugs, and stated that he had not attempted to work since his 1985 retirement, feeling that he could not interact appropriately with others. Test results were consistent with feelings of depression, insecurity, poor self-confidence and self-esteem, feelings of inferiority, a disrupted thinking process, confusion, preoccupation with odd and obscure incidents, and more than the usual amount of suspiciousness and odd incidents than might be expected. His ability to achieve and maintain good social relationships and to retain employment were described as severely impaired. The reporting VA psychologist stated that the veteran was both competent and employable, and could continue to slowly achieve rehabilitative gains. The diagnoses included Axis I: PTSD, chronic; Axis II: Major depressive disorder, recurrent and moderate; Axis IV: Psychosocial Stressors: bereavement, unemployment, poverty and family problems; and Axis V: GAF, current 45; past year, 45, indicative of serious symptoms or serious impairment in social, occupational or school functioning. A report of VA psychiatric examination, conducted in March 1997, cited the examiner's review of the veteran's claims folder, and his personal, legal, psychiatric, and substance abuse history; his past occupational experience; and noted the recent deaths of his father and brother, his wife's chronic illness and inability to walk, and his mother's cancer. He complained of depression, avoidant behaviors, suicidal ideation, insomnia, outbursts of temper, easy irritability, detachment and difficulty concentrating, and recurrent distressing dreams. He alleged that he stayed in his basement all the time; that he did not want to go out; and that he wanted to isolate himself because his PTSD symptoms were very severe. Mental status examination disclosed that the veteran appeared haggard and disheveled, and showed mild psychomotor retardation; that he was oriented as to person and place, but not to time; that his affect was inappropriate and his memory for recent or remote events was patchy; that he admitted suicidal, homicidal, and paranoid ideation; that he was withdrawn, lacked self-esteem, self-confidence, and motivation, and had poor impulse control; that judgment and insight were impaired; that intellectual functioning was average, and that his concentration was poor. The diagnoses included Axis I: PTSD, severe, chronic; recurrent depression with psychotic features; history of alcohol abuse, history of drug abuse (cocaine and marijuana; Axis II: Rule out antisocial personality disorder; Axis IV: Psychosocial Stressors: severe: no gainful employment, history of alcohol and drug abuse, death of his father and brother, financial problems, wife has chronic debilitating disease; Axis V: GAF, current and past year 45, indicative of serious symptoms or serious impairment in social, occupational or school functioning. Records contained in the veteran's Vocational Rehabilitation & Education folder (Chapter 31) show that the veteran continued to pursue his educational program at Ursuline College from August to December 1997, maintaining a three- quarter time course load (9 hours); and that his attendance continued uninterrupted. A December 1997 report of contact with the veteran prepared by a counseling psychologist in VA's Vocational Rehabilitation & Counseling Division indicated that he had spoken with the veteran; that the veteran expected to graduate in May 1998 rather than in December 1998; that changes in his schedule would be needed; and that he wanted to be paid continuously. He was informed that written verification would be needed. A VA Form 119, Report of Contact, dated in January 1998, indicated that a discussion with the veteran's counseling psychologist revealed that the veteran had continuously attended school on a full time basis except for some interruptions caused by deaths of close family members; that he was progressing well and receiving good grades; that the veteran would have used the maximum of 96 months upon completion of his Bachelor's Degree in Psychology; that at that time he would be qualified for over 200 jobs; and that his curriculum required regular interaction with faculty and students. A Supplemental Statement of the Case was issued in January 1998 addressing the issues of a rating in excess of 50 percent for PTSD; a total disability rating based on unemployability due to service-connected disability; and clear and unmistakable error concerning the failure to address the issue of total disability rating based on individual unemployability due to service-connected disability in rating decisions prior to and after the Board decision of April 1991. Records contained in the veteran's Vocational Rehabilitation & Education folder (Chapter 31) show that the veteran continued to pursue his BA degree in Psychology program at Ursuline College from December 1997 through May 1998, his scheduled date of graduation; and that he maintained a three- quarter time course load (9 hours). At that time, the veteran had used a total of 96 hours of Vocational Rehabilitation (Chapter 31) benefits, including 60 hours in his previous Nursing and other programs. Another VA Form 9 was received in February 1998 waiving the veteran's previous requests for RO or travel board hearings; waiving initial RO review of additional evidence submitted; waiving the right to receive any additional Supplemental Statements of the Case; and seeking a schedular 100 percent rating for PTSD, a total disability rating based on unemployability due to service-connected disability, and an effective date in accordance with law and regulations. In addition, that document again stated that the veteran disagreed with "all denials of benefits to which he (or she) [sic] may be entitled, including those benefits which have not been specifically identified but should reasonably have been inferred by the VA." Further, the veteran was said to claim entitlement to service connection for all such unidentified benefits. The veteran's appeal came before the Board in April 1998, at which time the Board denied the claims of clear and unmistakable error in certain prior rating decisions by the RO which failed to infer and adjudicate the issue of a total disability rating based on unemployability due to service- connected disability prior to or after the Board decision of April 1991. The Board also remanded to the RO for adjudication the issues of entitlement to a extraschedular evaluation for PTSD under the provisions of 38 C.F.R. § 3.321(b)(1); entitlement to service connection for anxiety, substance abuse, and a dysthymic disorder as secondary to service-connected PTSD under the provisions of 38 C.F.R. § 3.310(a) (1997), including consideration under the principles enunciated by the Court in Allen v. Brown, 7 Vet. App. 439, 448 (1995); and readjudication of the claims for entitlement to a rating in excess of 50 percent for PTSD; and entitlement to a total disability rating based on unemployability due to service-connected PTSD in light of the determinations reached with respect to the currently pending and unadjudicated claims of entitlement to entitlement to a extraschedular evaluation for PTSD under the provisions of 38 C.F.R. § 3.321(b)(1) and the claim for entitlement to service connection for anxiety, substance abuse, and a dysthymic disorder as secondary to service-connected PTSD. A May 1998 letter to the veteran's attorney from Walter P. Knake, Jr., a private psychologist, stated that he was writing at the veteran's request; that he had reviewed the data contained in a packet of information provided by the veteran's attorney; and that there was enough information in that packet of information to warrant the veteran's receipt of a schedular 100 percent evaluation. He further stated that he continued to see the veteran; that the veteran was mistrustful and not very comfortable around other people; that he exhibited intense withdrawal and social isolation; and that he related a range of symptomatology associated with PTSD. He stated that it was his professional opinion that the veteran was unemployable and deserved a 100 disability rating. Another VA psychiatric examination was conducted on June 5, 1998. At that interview, the veteran submitted a letter in which he reiterated his past statements concerning the severity of his PTSD symptomatology; expressed concern about the safety of his family; and stated that he doesn't associate with his neighbors; that he had not allowed a visitor other than another veteran into his house in over 20 years; that he isolated himself from everyone and spent most of his time in his basement; and that over the years several of his physicians had expressed the opinion that he was totally disabled due to his PTSD. He asked that he be permitted to tape record the psychiatric interview. The report of VA psychiatric examination conducted in June 1998 cited the veteran's statements that he graduated from high school, had one year of college, and took up nursing at Case Western Reserve College, but did not go through with it. He related that he began drinking at age 16, drank heavily and used marijuana and cocaine while in service, but had discontinued the use of alcohol, cocaine, marijuana, and tobacco. He recounted his history of traumatic stressors while in Vietnam, became angry, and started to cry. He had been married for 27 years, but reported that he did not have an intimate relationship with his spouse. His prior treatment history was noted, including repeated hospitalizations for detoxification and at the Center for Stress Recovery, and he recounted his PTSD symptomatology in detail, including the assertion that he stayed in his basement and refused to be with other people. He was accompanied by his mother and was very angry, agitated and tearful, stating that he was tired of telling the same stories over and over. Mental status examination disclosed that the veteran was well oriented and cooperative; that his speech was coherent and relevant, and that his affect was appropriate. He appeared very nervous and anxious, and his mood was depressed. His memory for recent and remote events was fair, intellectual function was average, and he denied suicidal or homicidal ideation. He could subtract serial seven's from 100, and knew the names of some past presidents. While his insight and judgment were impaired, he was capable of managing his funds in his own best interest. The diagnoses were: Axis I: PTSD; alcohol dependence, by history; marijuana and cocaine abuse, by history; nicotine dependence, by history; Axis II: None; Axis IV: Psychosocial Stressors: severe: traumatic experience in Vietnam; no gainful employment; addiction consequences; legal history; marital difficulties; Axis V: GAF, current and past 45, indicative of serious symptoms or serious impairment in social, occupational or school functioning. The examiner expressed her opinions that the veteran continued to have classic symptoms of PTSD; that he had severe impairment of social and industrial adaptability; and that his depression and anxiety were symptoms of his PTSD. She further expressed the opinion that his substance abuse was secondary to his PTSD, but noted that the veteran had been sober for the past six to seven years. A rating decision of March 1999 granted a schedular 100 percent disability rating for PTSD, effective June 5, 1998, the date of the VA examination showing that the schedular criteria for that rating were met. In addition, that rating decision determined that such total schedular disability was permanent in nature; and granted entitlement to Dependents' Educational Benefits under the provisions of 38 U.S.C.A., Chapter 35 (1999). The rating decision of March 1999 further determined that the veteran was not entitled to an extraschedular evaluation for PTSD under the provisions of 38 C.F.R. § 3.321(b)(1); that the veteran was not entitled to special monthly compensation based upon the need for aid and attendance or by reason of being housebound under the provisions of 38 U.S.C.A. §§ 1114(l) or (s); that the veteran was not entitled to service connection for anxiety and a dysthymic disorder as secondary to service-connected PTSD; that the veteran was not entitled to service connection for alcoholism and substance abuse disorder as secondary to service-connected PTSD; and that the veteran was not entitled to a total disability rating based on unemployability due to service-connected disability between May 31, 1999 and June 5, 1999. The veteran was notified of those determinations and of his right to appeal by RO letter of April 12, 1999, and a Supplemental Statement of the Case was issued in April 1999 addressing the issue of a rating in excess of 50 percent for PTSD. On May 5, 1999, another Substantive Appeal (VA Form 9) was submitted, with additional documents and materials attached, including a duplicate of the VA form 9 submitted in February 1998. The Substantive Appeal of May 5, 1999 stated that it was submitted in response to the Supplemental Statement of the Case issued in April 1999. In the accompanying documents, it was stated that "[t]he SSOC of March 30, 1999 which increased [the appellant's] schedular to 100 percent effective June 5, 1998 did so based on a VA examination done on that date"[,] and that "as the RO has recently granted [the appellant] 100 percent schedular, [the appellant] disputes only the effective date [sic]." It was further indicated that the veteran continued his appeals for a total disability rating based on unemployability due to service- connected disability and the claims of clear and unmistakable error in prior rating decisions by the RO which failed to infer and adjudicate the issue of a total disability rating based on unemployability due to service-connected disability prior to or after the Board decision of April 1991. The Board notes that the claims of clear and unmistakable error in certain prior rating decisions by the RO were denied by the Board in its April 1998 decision. Additional documents submitted with the veteran's May 5, 1999 Substantive Appeal included a statement that "The subject veteran specifically WAIVES the following: (1) the sixty (60) day waiting period to comment on any additional information contained in the Supplemental Statement of the Case. (2) the sixty (60) day period to submit additional information or evidence in response to the Supplemental Statement of the Case. (3) any prior request(s) for a hearing before a [RO] and/or BVA hearing officer. (4) the right to have the [RO] prepare any subsequent Supplemental Statement of the Case(s), Rating Decision(s), Decisional Officer Decision(s), Compensation and Pension Examinations, and any other action by this agency prior to the transfer of the Veteran's claims folder to the BVA (emphasis in original)." II. Analysis The Board construes the above-cited Substantive Appeal (VA Form 9) filed on May 5, 1999 and the accompanying statement that "as the RO has recently granted [the appellant] 100 percent schedular, [the appellant] disputes only the effective date[,]" as a Notice of Disagreement with the effective date of the assignment of the 100 percent schedular evaluation for the veteran's service-connected PTSD. The Court has held that on a claim for an original or increased rating, the claimant will generally be presumed to be seeking the maximum benefit allowed by law and regulation, and it follows that such a claim remains in controversy where less than the maximum available benefit is awarded. Cf. Swan v. Derwinski, 1 Vet. App. 20, 20-23 (1990). Where a claimant has filed a NOD as to an RO decision assigning a particular rating, a subsequent RO decision awarding a higher rating, but less than the maximum available benefit, . . .does not abrogate the pending appeal. AB v. Brown, 6 Vet. App. 35, 38 (1993). The Board finds that the claim for a rating in excess of 50 percent for PTSD encompasses a claim for all potentially available higher ratings, including the maximum schedular rating; that the assignment of a schedular 100 percent rating, effective more than seven years after the date of the reopened claim for a rating in excess of 50 percent for PTSD does not represent the maximum available benefit; that no final decision has been rendered as to the reopened claim for increase; and that the claim remains open as to the issue of a effective date prior to June 5, 1998 for assignment of a schedular 100 percent disability rating for PTSD. Further, the Court has held that even after a claimant files a Substantive Appeal, and before the Board renders a decision, he or she can present to the Board his or her version of the issues and that, if both VA and the claimant have fulfilled their respective obligations, the points at issue should be defined and refined for the Board to review and resolve. Stuckey v. West, No. 96-1373 (U.S. Vet. App. Nov. 17, 1999). The Court compared that process to the pleading system of trial courts, with VA guiding the claimant and his representative to identify, with some degree of specificity, the sources of his dissatisfaction with the RO decision, and noted that it was the responsibility of both VA in the SOC and the appellant in the substantive appeal to identify issues of fact and law. Stuckey, No. 96-1373 (U. S. Vet. App. Nov. 17, 1999). In addition, the Board notes that the Supplemental Statement of the Case issued in April 1999 includes a citation of all pertinent law and regulations pertaining to effective dates, as well as the newly revised criteria for evaluating mental disabilities which became effective November 7, 1996, and that the appellant has waived any additional Supplemental Statements of the Case, rating decisions, decisional officer decisions, compensation and pension examinations, and any other action by the agency prior to the transfer of the veteran's claims folder to the BVA. Accordingly, the Board finds that the veteran will not be prejudiced by its addressing the issue of an effective date prior to June 5, 1998, for assignment of a schedular 100 percent rating for PTSD without a further remand to the RO. With respect to the issue of a total rating based on unemployability due to service-connected disability, a VA General Counsel Opinion (VAOPGCPREC 6-99), dated June 7, 1999, stated, inter alia, that because a 100 percent schedular rating and a total disability rating under 38 C.F.R. Part 4, § 4.16(a) each reflect unemployability, if an individual has a 100 percent schedular rating, a determination that the individual is unemployable as a result of service-connected disabilities under § 4.16(a) is unnecessary to adequately compensate the individual and is superfluous. In other words, VA can find the veteran to be totally disabled either under the rating schedule or, if the veteran does not meet the criteria for a 100 percent schedular rating but is in fact unemployable, under § 4.16(a). Accordingly, it was held that a claim for a total disability rating based on individual unemployability for a particular service-connected disability may not be considered when a schedular 100 percent rating is already in effect for another service-connected disability. It was further held that no additional monetary benefit would be available in the hypothetical case of a veteran having one service-connected disability rated 100 percent under the rating schedule and another, separate disability rated totally disabling due to individual unemployability under 38 C.F.R. Part 4, § 4.16(a). Further, the availability of additional procedural protections applicable under 38 C.F.R. § 3.343(c) in the case of a total disability rating based on unemployability would not provide a basis for consideration of a rating under § 4.16(a) where a veteran already has a service-connected disability rated 100 percent disabling under the rating schedule. See VAOPGCPREC 6-99. In view of the RO's determination that the veteran is entitled to a schedular 100 percent disability rating for his service-connected PTSD, effective June 5, 1998, the Board does not reach the issue of entitlement to a total disability rating based on unemployability due to service-connected disability on and after June 5, 1998. Rather, the Board finds the appeal as to that issue moot as of June 5, 1998. See Vettese v. Brown, 7 Vet. App. 31, 34-35 (1994); VAOPGCPREC 6-99. However, that determination does not dispose of the issue of entitlement to a total disability rating based on unemployability due to service-connected disability from May 31, 1991, the date of receipt of the veteran's reopened claim for a higher disability rating for his service-connected PTSD, or some earlier effective date, under all applicable law and regulations. Entitlement to an Effective Date Prior to June 5, 1998 for Assignment of a Schedular 100 Percent Evaluation for PTSD or For a Total Disability Rating Based on Unemployability Due to Service-Connected Disability The medical evidence in this appeal has been described in full and will be cited by reference, but not reiterated, in this portion of the decision. The record shows that service connection for PTSD was established, effective March 1, 1986, and a 30 percent evaluation was assigned for that disability. The Board decision of April 1991 denied entitlement to a rating in excess of 30 percent for PTSD prior to March 9, 1990, and denied a rating in excess of 50 percent for PTSD thereafter. Implicit in that appellate decision was a determination that the veteran's disability did not meet the schedular criteria then in effect for any of the higher ratings available for that disability, including the 70 percent evaluation required for consideration under 38 C.F.R. § 4.16(c), or a schedular 100 percent evaluation as provided in 38 C.F.R. Part 4, § 4.132, Diagnostic Code 9411 (prior to November 7, 1996), including any of the three independent criteria required for a 100 percent PTSD rating. That decision was not appealed to the United States Court of Appeals for Veterans Claims (Court) within the statutory period and became final. On May 31, 1991, the veteran reopened his claim for a rating in excess of 50 percent for PTSD. Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the present level of disability is the primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). However, that claim for increase has remained at issue since received in May 1991, and the Board will review the medical evidence of record as it pertains to that disability from the date of receipt of the veteran's reopened claim. When evaluating a mental disorder, the rating agency considers the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the veteran's capacity for adjustment during the periods of remission. An evaluation is assigned based on all the evidence of record that bears on occupational and social impairment rather than solely on the examiner's assessment of the level of disability at the moment of the examination. The rating agency will consider the extent of social impairment, but shall not assign an evaluation solely on the basis of social impairment. 38 C.F.R. § 4.126 (1998). 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 the rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7 (1998). Pursuant to Karnas v. Derwinski, 1 Vet. App. 308 (1991), where a law or regulation changes after the claim has been filed or reopened before administrative or judicial review has been concluded, the version most favorable to the veteran applies unless Congress provided otherwise or permitted the VA Secretary to do otherwise and the Secretary did so. This veteran has appealed the RO's rating action of May 1991 which denied a rating in excess of 50 percent for his service- connected PTSD. Effective November 7, 1996, VA revised the criteria for diagnosing and evaluating psychiatric disabilities, including PTSD. 61 Fed. Reg. 52,695 (1996). On and after that date, all diagnoses of mental disorders for VA purposes must conform to the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). 61 Fed Reg. 52,700 (1996), now codified at 38 C.F.R. §§ 4.125- 4.130). The new criteria for evaluating service-connected psychiatric disability are codified at newly designated 38 C.F.R. § 4.130. 61 Fed. Reg. 52,700-1 (1996). The new rating criteria are sufficiently different from those in effect prior to November 7, 1996, that the RO and the Board are required to evaluate the veteran's service-connected PTSD by applying the criteria contained in the VA Schedule for Rating Disabilities related to psychiatric disability as it was in effect prior to November 7, 1996, as well in accordance with the revised criteria that became effective on that date. Karnas, at 311. The record shows that the RO has done so. VA's Schedule for Rating Disabilities in effect prior to November 7, 1996 provides that the evaluation of psychoneurotic disorders, including PTSD, is based upon a General Rating Formula for Psychoneurotic Disorders codified under 38 C.F.R. Part 4, § 4.132. Under those criteria, a 50 percent evaluation for PTSD is warranted where the ability to establish or maintain effective or favorable relationships with people is considerably impaired and, by reason of psychoneurotic symptoms, the reliability, flexibility and efficiency levels are so reduced as to result in considerable industrial impairment, while a 70 percent evaluation is warranted for PTSD where the ability to establish and maintain effective and favorable relationship with people is severely impaired, and the psychoneurotic symptoms are of such severity and persistence that there is severe impairment in the ability to obtain and retain employment. A 100 percent evaluation is warranted for PTSD where the attitudes of all contacts except the most intimate are so adversely affected as to result in virtual isolation in the community; or 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 result in profound retreat from mature behavior, or the claimant is demonstrably unable to obtain or retain employment. 38 C.F.R. Part 4, § 4.132, Diagnostic Code 9411 (in effect prior to November 7, 1996). Effective November 7, 1996, mental disorders, such as PTSD, are now assigned disability ratings based on a General Rating Formula for Mental Disorders described at 38 C.F.R. Part 4, § 4.130 (1999). That formula provides that 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 will be rated as 50 percent disabling. Occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to symptoms such 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 work-like setting); and inability to establish and maintain effective relationships will be rated as 70 percent disabling. 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 will be rated as 100 percent disabling. 38 C.F.R. Part 4, § 4.130, Diagnostic Code 9411 (1998). During the pendency of this appeal, the formula for evaluating PTSD changed, as described above. Following the Board's remand in April 1998, the RO re-evaluated the veteran's case under both the old and the new criteria, reviewing all VA psychiatric examinations, psychological testing, and other records, and determined that a rating in excess of the currently assigned 50 percent disability rating was not warranted given the veteran's symptomatology. In cases such as this, the Board also considers both the old and new rating formulas for evaluation of acquired psychiatric disorders, including PTSD, and applies the formula which is most favorable to the claimant. Karnas, at 470. Since this case was reopened in May 1991, application of the criteria in effect prior to November 7, 1996, would encompass consideration of his claim under the provisions of 38 C.F.R. § 4.16(c), in effect prior to November 7, 1996. Apart from that, the Board finds that the outcome of the veteran's appeal would not be changed by application of either the old or the new criteria, and the Board has considered both in its review of the evidence and determination. The Board's review of the medical record in this case shows, in pertinent part, that the veteran was enrolled in a pre- nursing program at Cuyahoga Community College in April 1989; that his academic record had been very good; that he had been married for 20 years and had five children; that in addition to PTSD symptoms, he experienced financial stresses and everyday pressures while attending classes; that he subsequently transferred to a degree program in Nursing at Case Western Reserve University, where he was doing "quite well"; that an assessment revealed no more than considerable social and occupational impairment; that the cessation of his frequent hospitalizations in March 1990 suggested improvement in his condition; and that he attributed his ongoing alcohol abuse as "mostly to sleep", while also citing frequent intrusive memories of his Vietnam experience. The Board notes that the veteran was not considered unemployable and that there is no indication that vocational rehabilitation was considered infeasible. Records contained in the veteran's Vocational Rehabilitation & Education folder (Chapter 31) show that in July 1992, his case was reviewed because of a request that he be granted an extension of Chapter 31 Vocational Rehabilitation & Educational training benefits; that he had maintained a GPA in excess of 2.5 during the Spring semester after some adjustment problems in the Fall semester; that the veteran's nursing program was necessary to overcome his employment handicap; that he had demonstrated that he could handle his training and practicum; that he was scheduled to complete his program in June 1995; and that he would be employed at the Cleveland Clinic for two years after his graduation. Although the veteran has contended that he has been unable to hold a job since 1985, the reports of VA psychiatric examination in December 1991 and in May 1993 show that on each occasion his Global Assessment of Functioning (GAF) score was shown to be 60, indicative of moderate symptoms or moderate difficulty in social, occupational or school functioning. The Board further notes that while both examination reports show diagnoses of alcohol abuse, in remission or by history, VA outpatient treatment records dated in July 1992 establish that the veteran's alcohol abuse was not, in fact, in remission. To the contrary, the veteran reported increased alcohol intake and missing classes, with an indication of medication noncompliance, and the diagnoses included alcohol abuse (binges). Further, while stating on the examination interview in May 1993 that he had quit school because he "could not handle it", the veteran failed to note that he had resumed classes in February 1993, and was attending college classes on a regular basis at the time of that examination. Although it is contended on appeal that the listed Axis IV stressors in May 1993 included marital separation and "unable to hold a job", those stressors were described as moderate, and the VA psychiatric examiner did not himself conclude that the veteran was unable to hold a job; rather, a GAF score of 60 was assigned, and the examiner noted only moderate difficulty in social and occupational functioning. While the report of VA psychological evaluation in May 1993 cited the veteran's assertions that his marital relationship was completely alienated, that he was isolated, and that he had dropped out of school in November 1992, there was no corresponding recognition that the veteran's spouse was chronically disabled and unable to walk; that his claimed isolation was mitigated by his regular school attendance and interaction with faculty and students; or that he had resumed classes in February 1993 and was attending classes at the time of that evaluation. The Board has considered the weight to be associated with the assigned GAF score of 45 in light of the interviewer's reliance upon veteran history, his indication that the psychological test results were exaggerated and reflected a display of distress, and his failure to appreciate the fact of the veteran's selective or inaccurate presentation of the facts. In addition, in assessing the weight to be accorded those opinions, the Board has taken into consideration the more extensive medical specialist training received by those physicians serving as VA psychiatric examiners. The Board further notes that, while the reports of VA psychiatric examination and psychological testing and evaluation in May 1993 both diagnosed an anti-social personality disorder in the veteran, neither attempted to distinguish the resulting symptomatology from that of the veteran's service-connected PTSD, or offered an opinion as to the degree to which that condition contributed to the veteran's social and industrial impairment, and another VA psychiatric examination was obtained. On a subsequent VA psychiatric examination in November 1993, the examiner cited the veteran's anger regarding his disability and his assertion that he "only drinks if [he can't] get [his] medication", and stated that the veteran's claim that he did not use street drugs was "not very convincing." He further found that the current examination revealed a very severe paranoid personality disorder, and that the veteran was obsessively preoccupied with the issue of discrimination of blacks and whites. The diagnoses included Axis I: PTSD by history; history of alcohol and drug abuse claimed by veteran to be "under control"; Axis II: Paranoid personality, severe; no Axis IV diagnosis; and an Axis V: GAF score of 55 to 60, indicative of moderate symptoms or moderate impairment in social, occupational or school functioning, and that "[T]he disability mostly appear[s] due to his severe personality disorder." The Board is precluded from differentiating between the symptomatology attributable to a nonservice-connected disability and that attributable to a service-connected disability in the absence of medical evidence making such distinction. However, the Board may not ignore such distinctions where they are based upon competent medical evidence included in the record. Mittleider v. West, 11 Vet. App. 181, 182 (1998). The Board accepts as accurate the cited findings and assigned GAF scores on VA psychiatric examinations in December 1991, in May 1993, and in November 1993 that the veteran's psychiatric disability was manifested by moderate social and industrial impairment, or moderate symptoms or moderate impairment in social, occupational or school functioning, and the specific findings in November 1993 that a significant portion of such disability was attributable to his nonservice-connected personality disorders. In addition, the Board notes that a report of VA outpatient interview in February 1997 shows that the veteran continued to express the obsessive racial ideation previously identified and associated with his diagnosed paranoid personality disorder, citing his statement that that there were racial reasons why he was only getting 30 [sic] percent while white men with PTSD were getting a higher rating. In addition, the Board has considered the fact that the report of VA psychiatric examination in November 1993 diagnosed PTSD only by history. While the June 1994 report from a private clinical psychologist expressed her opinion that the veteran had been unemployable since November 1985, that report indicated that the author had not clinically interviewed the veteran; had not reviewed the veteran's medical records apart from those selected by his private attorney; made no mention of the veteran's Axis II diagnoses which included severe paranoid personality and antisocial personality disorder; appeared to be unaware of the veteran's extensive period of alcohol and substance abuse and indications that such abuse was continuing; failed to distinguish or discuss symptomatology stemming from psychiatric disability other than PTSD; and failed to weigh the impact of those conditions upon the veteran's employability or to state that such had no impact. In addition, that report focused primarily upon medical evidence of the veteran's condition during the period from November 1985 through July 1988, and provided a rather cursory treatment of evidence dated in June 1991, January 1992, and VA reports in May 1993, which did not support her view that the veteran was unemployable. In fact, none of the VA psychiatrists who examined the veteran in December 1991, May 1993, and November 1993 found the veteran to be unemployable. The Board finds, for the reasons stated, that the June 1994 report from a private clinical psychologist is entitled to only limited weight in assessing the degree of the veteran's psychiatric disability stemming from his service-connected PTSD. The Board has the duty to assess the credibility and weight to be given to the evidence, and to give sufficient reasons and bases for accepting or rejecting critical evidence, expert or otherwise. Gilbert v. Derwinski, 1 Vet. App. 49, 57-58 (1990); Wood v. Derwinski, 1 Vet. App. 190, 192 (1991); reconsidered, 1 Vet. App. 406 (1991). For the reasons and bases set forth above, the Board's review of the evidence submitted from the date of the veteran's reopened claim through the receipt of the June 1994 report from a private clinical psychologist does not establish that the disability resulting from the veteran's service-connected PTSD was more than moderate during that period; that a rating in excess of 50 percent is warranted during that period; or that the veteran was unemployable as a result of his service- connected mental disorder at any time during that period. Thereafter, VA outpatient clinic records dated in March 1996 show that the veteran's father and brother had died; that he had been off his medications for two months; and that he needed medication refills. As previously noted, subsequent entries in February 1997 show that the veteran continued to express racially-oriented ideation associated with his diagnosed paranoid personality disorder. The record further shows that the veteran was awarded Vocational Rehabilitation & Educational (Chapter 31) benefits to pursue a Bachelor's Degree in Psychology program at Ursuline College; beginning January 1997 and continuing through August 1998; and that he began that program at the three-quarter time rate (9 credit hours) in January 1997. A March 1997 letter from a private psychologist, written at the veteran's request, indicated, in pertinent part, that he had seen the veteran since April 1996; that the veteran had been assigned a diagnosis of PTSD and continued to experience PTSD symptomatology; and that it was his professional opinion that the veteran was unemployable at the present time and met the criteria for a 100 percent schedular evaluation for his PTSD. He estimated the veteran's level of psychological functioning, which he defined as his GAF score, as 3.5 [sic]. However, a report of VA psychological evaluation, also conducted in March 1997, noted that test results were consistent with feelings of depression, insecurity, poor self-confidence and self-esteem, feelings of inferiority, a disrupted thinking process, confusion, preoccupation with odd and obscure incidents, and more than the usual amount of suspiciousness and odd incidents than might be expected. While the veteran's ability to achieve and maintain good social relationships and to retain employment was described as severely impaired, the reporting VA psychologist stated that the veteran was both competent and employable, and could continue to slowly achieve rehabilitative gains. The diagnoses included Axis I: PTSD, chronic; Axis II: Major depressive disorder, recurrent and moderate; Axis IV: Psychosocial Stressors: bereavement, unemployment, poverty and family problems; and Axis V: GAF, current 45; past year, 45, indicative of serious symptoms or serious impairment in social, occupational or school functioning. On VA psychiatric examination on June 5, 1998, the veteran again asserted that he isolated himself from everyone and spent most of his time in his basement, failing to inform the examiner that he had continuously attended college in a Bachelor's Degree program from January 1997 though the date of examination. He had been married for 27 years, but reported that he did not have an intimate relationship with his spouse, failing to acknowledge that his spouse had suffered a chronic disabling disease, Guillain-Barre` Syndrome, since 1979, with paralysis of the lower extremities. Mental status examination disclosed that, while the veteran appeared very nervous and anxious, his mood was depressed, and his insight and judgment were impaired, he remained well oriented and cooperative; speech was coherent and relevant; affect was appropriate; memory for recent and remote events was fair; intellectual function was average, calculation was intact; he denied suicidal or homicidal ideation; and he competent and capable of managing his funds in his own best interest. The diagnoses included were: Axis I: PTSD; alcohol dependence, by history; marijuana and cocaine abuse, by history; Axis IV psychosocial stressor were described as severe: traumatic experience in Vietnam; no gainful employment; addiction consequences; legal history; marital difficulties; Axis V: GAF, current and past 45, indicative of serious symptoms or serious impairment in social, occupational or school functioning. In addition, the examiner expressed her opinions that the veteran continued to have classic symptoms of PTSD; that he had severe impairment of social and industrial adaptability; that his depression and anxiety were symptoms of his PTSD; and that his substance abuse was secondary to his PTSD, while noting that the veteran had been sober for the past six to seven years. On the basis of that examination report, a schedular 100 percent evaluation was granted, effective June 5, 1998, the date of that examination. Therefore, the Board's consideration on appellate review must necessarily be directed toward finding evidence showing that the criteria for a schedular 100 percent evaluation, to include all ratings in excess of 50 percent, were met prior to June 5, 1998. The Board notes that neither the private nor the VA psychological evaluation reports in March 1997 addressed the fact that the veteran was then attending classes at the three-quarter time rate at Ursuline College pursuing a Bachelor's Degree in Psychology, and further notes that the report of VA psychological testing identified the veteran's psychosocial stressors as bereavement, unemployment, poverty and family problems, rather than stressors associated with service trauma or PTSD symptomatology. To the same point, the March 1997 report of VA psychiatric examination cited the veteran's personal, legal, psychiatric, and substance abuse history; noted the recent deaths of his father and brother, his wife's chronic illness and inability to walk, and his mother's cancer, and recounted the veteran's assertions that he stayed in his basement all the time; that he did not want to go out; and that he wanted to isolate himself because his PTSD symptoms were very severe. The diagnoses included Axis I: PTSD, severe, chronic; recurrent depression with psychotic features; history of alcohol abuse, history of drug abuse (cocaine and marijuana); Axis II: Rule out antisocial personality disorder; Axis IV: Psychosocial Stressors: severe: no gainful employment, history of alcohol and drug abuse, death of his father and brother, financial problems, wife has chronic debilitating disease; Axis V: GAF, current and past year 45, indicative of serious symptoms or serious impairment in social, occupational or school functioning. None of those examination reports made any effort to verify or distinguish any symptomatology stemming from the veteran's personality disorders from his PTSD symptomatology, although most of his disability was reported to be due to his paranoid personality disorder on VA psychiatric examination in November 1993. However, the cited report of VA psychiatric examination in March 1997 also failed to acknowledge or take into consideration the fact that the veteran was then attending regular classes at the three-quarter time rate at Ursuline College; and associated the veteran's psychosocial stressors with having no gainful employment, history of alcohol and drug abuse, death of his father and brother, financial problems, [and] wife has chronic debilitating disease, rather than stressors associated with service trauma or PTSD symptomatology. To the same point, the Board notes that both the veteran's assertions that he stayed in his basement all the time and did not want to go out, and the reported clinical finding that he was not oriented as to time; that his memory for recent or remote events was patchy; and that his concentration was poor are inconsistent with the veteran's contemporaneous attendance at Ursuline College, and his creditable academic performance in his Bachelor's Degree program. The Board is mindful that the Court has acknowledged arguments to the effect that "the skills needed to attend school are different from the skills needed to compete successfully in the workplace." Washington v. Derwinski, 1 Vet. App. 459, 465 (1991). However, in Washington, the Court noted that there was no evidence in the record that the veteran was successfully pursuing his studies, while in the instant appeal, documentary evidence of such success is specific, extensive, and easily quantified. To that particular point, records contained in the veteran's Vocational Rehabilitation & Education folder (Chapter 31) show that he continued to pursue his educational program at Ursuline College from August to December 1997, maintaining a three-quarter time course load (9 hours); and that the veteran expected to graduate in May 1998 rather than in December 1998. Further, in January 1998, the veteran's counseling psychologist revealed that the veteran had continuously attended school on a full time basis except for some interruptions caused by deaths of close family members; that he was progressing well and receiving good grades; that a maximum of 96 months would have been used upon completion of his Bachelor's Degree in Psychology; that at that time he would be qualified for over 200 jobs; and that his curriculum required regular interaction with faculty and students. These facts directly contradict the May 1998 letter from the veteran's private psychologist to the effect that the veteran exhibits intense withdrawal and social isolation. Further, the documented fact that the veteran has spent years pursuing academic goals in the classroom, meeting his classes in a timely fashion, having regular interaction with faculty and other students, and earning good grades calls into question such findings on VA examination as "not [oriented] as to time"; that his "memory for recent or remote events was patchy"; and that his "concentration was poor", or that he "stayed in his basement all the time." The Board has assessed the credibility and weight to be given to the evidence added to the record since the private psychologist's report of June 1994, as required by Gilbert, id., at 57-58 (1990) and Wood, id., at 192 (1991). While the Board does not take the position that the veteran's years of attending college classes are dispositive of the issue of employability, it notes that the record contains competent evidence from counseling psychologists and other Vocational Rehabilitation specialists pertaining to the veteran's status; that those individuals monitored the veteran's progress in his Vocational Rehabilitation program on an on- going basis; and that such evidence documents that the veteran successfully pursued vocational rehabilitation training from 1989 to December 1998 except for brief periods brought on by a renewal of the veteran's alcoholic binges and medication noncompliance, and subsequently by serious illness and death in the veteran's immediate family. Further, the record shows that the veteran's academic progress and grades were variously characterized as "very good", "working hard", "doing quite well", "attend[s] school regularly", "progressing well", and that he was "receiving good grades." In addition, the Board attaches substantial weight to evidence of the veteran's leaving his home on a regular basis for class attendance, meeting classes and scheduled VA examinations in a timely manner, having regular interaction with faculty and other students in his Bachelor's Degree program, and earning good grades, and finds that such militates against a conclusion that the veteran has social and industrial impairment or inadaptability which is severe in degree, or which would warrant assignment of a rating in excess of 50 percent for PTSD. To the contrary, the Board finds that the veteran's PTSD symptomatology is largely self-reported, not witnessed or clinically observed; that there is a great reliance on the veteran's symptom reports as to the degree of his impairment, his activities in his home, the nature of his relationship with family members, and his claimed isolation; and that the veteran's symptomatology appears to become most severe at those times when he is undergoing psychiatric evaluation for compensation purposes. Further, while unemployability is reported to be among the veteran's psychosocial stressors, there is no evidence that the veteran is concerned about his unemployed status or that he currently seeks or has sought employment, and his VA Form 21-8940 states clearly that he has not sought employment since November 1985. While the Board may not substitute its judgment for competent medical evidence contained in the record, the Board is charged with the duty to assess the credibility and weight to be given to the evidence, and to give sufficient reasons and bases for accepting or rejecting critical evidence, expert or otherwise. Gilbert, id., at 57-58 (1990); Wood, id., at 192 (1991). For the reasons stated, the Board finds that the record in this case does not establish that the veteran's ability to establish or maintain effective or favorable relationships with people was more than considerably impaired or that reliability, flexibility and efficiency levels were so reduced by reason of psychoneurotic symptoms as to result in more than considerable industrial impairment such as to warrant assignment of a rating in excess of 50 percent at any time prior to June 5, 1998, under the criteria in effect prior to November 7, 1996. Nor does that record establish the presence of 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 such as to warrant assignment of a rating in excess of 50 percent at any time prior to June 5, 1998 under the criteria in effect on and after November 7, 1996. Further, the record, taken in its entirety, does not establish that the veteran's ability to establish and maintain effective and favorable relationship with people was so severely impaired, or that his psychoneurotic symptoms were of such severity and persistence that there was severe impairment in the ability to obtain and retain employment such as to warrant a 70 percent evaluation at any time prior to June 5, 1998, under the criteria in effect prior to November 7, 1996. Neither does the evidence of record demonstrate a level of occupational and social impairment, with deficiencies in areas such as work, school, family relations, judgment, thinking, or mood, due to symptoms such 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 work-like setting); and inability to establish and maintain effective relationships such as to warrant assignment of an increased rating of 70 percent disabling at any time prior to June 5, 1998, under the criteria in effect on and after or to November 7, 1996. As entitlement to a 70 percent evaluation for PTSD is not demonstrated under the criteria in effect prior to November 7, 1996, and unemployability was not demonstrated prior to June 5, 1998, the Board does not reach the issue of entitlement to a total disability rating based on unemployability under the provisions of 38 C.F.R. Part 4, § 4.16(c). That regulation, also in effect prior to November 7, 1996, requires that the claimant's only service-connected disability be a mental disorder assigned a 70 percent evaluation, and that such mental disorder preclude the claimant from securing a substantially gainful occupation. As the veteran did not meet the criteria for a 70 percent evaluation for his PTSD, and there was no credible showing of unemployability at any time prior to June 5, 1998, no basis for consideration under that regulation was established. The Board has also considered the veteran's entitlement to a schedular 100 percent evaluation in light of the fact that the criteria provided under 38 C.F.R. Part 4, § 132, Diagnostic Code 9411, in effect prior to November 7, 1996, are each independent bases for granting a 100 percent rating. See Johnson v. Brown, 7 Vet. App. 95, 97 (1994). However, a schedular 100 percent evaluation for PTSD under the provisions of 38 C.F.R. Part 4, § 132, Diagnostic Code 9411 requires competent medical evidence showing that the attitudes of all contacts except the most intimate are so adversely affected as to result in virtual isolation in the community; or demonstrating 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 result in profound retreat from mature behavior, or establishing that the claimant is demonstrably unable to obtain or retain employment. The veteran does not meet, and has not met, any of the independent bases for granting a 100 percent rating at any time prior to June 5, 1998 under the criteria set out in 38 C.F.R. Part 4, § 132, Diagnostic Code 9411, in effect prior to November 7, 1996. For the reasons and bases discussed at length earlier in this analysis, neither does the record demonstrate 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 such as to warrant a schedular 100 percent disabling under 38 C.F.R. Part 4, § 4.130, Diagnostic Code 9411 at any time prior to June 5, 1998. Rather, the several reports of VA psychiatric examinations from the date of the veteran's reopened claim in May 1991 to March 1997 show only moderate symptoms or moderate difficulty in social, occupational or school functioning; a report of VA psychological testing and evaluation in March 1997 stated that the veteran was both competent and employable; and the report of VA psychiatric examination in March 1997 disclosed serious symptoms or serious impairment in social, school, or school functioning without distinguishing the symptomatology associated with the veteran's documented diagnoses of PTSD, recurrent depression with psychotic features, history of alcohol and drug abuse, and anti-social personality disorder. The Board notes that the only VA psychiatric examination which provided such a distinction found that the veteran's psychiatric disability "mostly appear[s] due to his severe personality disorder." The veteran has also advanced additional arguments in support of his claim for a schedular 100 percent rating prior to June 5, 1998, or a total rating based on unemployability due to service-connected disability under the provisions of 38 C.F.R. Part 4, § 4.16(a) and (b) prior to June 5, 1998. Under the provisions of 38 U.S.C.A. § 5110(a) (West 1991& Supp. 1998) and 38 C.F.R. § 3.400 (1999), the effective date of an evaluation and award of VA disability compensation benefits based upon a claim for increase will be the date of receipt of the claim or the date entitlement arose, whichever is the later. 38 U.S.C.A. § 5110(a) (West 1991); 38 C.F.R. § 3.400 (1999). The effective date of an evaluation and award of VA disability compensation benefits based upon a claim for increased disability compensation will be the earliest date that it is factually ascertainable that an increase in disability had occurred if the claim is received within one year from such date; otherwise date of receipt of claim. 38 C.F.R. § 3.400(o)(2) (1999). The record shows that a final Board decision of April 1991 denied a rating in excess of 50 percent for PTSD. There is no factual dispute as to the date of receipt at the RO of the veteran's reopened claim for a rating in excess of 50 percent for PTSD, established by date-stamp, and no contention that he applied for an increased rating for that disability at any earlier date. The veteran's application for a total disability rating based on unemployability due to service-connected disability (VA Form 21-8940) was received at the RO on March 7, 1994, as established by date-stamp. While it is alleged that the veteran in some manner submitted an informal claim for a total disability rating based on unemployability due to service-connected disability prior to the date of receipt of his formal application, the Board finds no evidence in the record to support that assertion. Governing regulations provide that any communication or action indicating an intent to apply for one or more benefits administered by VA, from a claimant, his or her duly authorized representative, a Member of Congress, or some person acting as next friend of a claimant who is not sui juris may be considered an informal claim. The informal claim must identify the benefit sought. 38 C.F.R. § 3.155(a) (1999). The Federal Circuit Court has upheld the determination by the Court of Appeals for Veterans Claims that under the Department's regulations an informal claim application must be written. Rodriguez v. West, No. 98-7087 (Fed. Cir. Aug. 25, 1999). The Board is not free to disregard its own regulations and is "required to apply all relevant statutes and regulations appropriate to the particular case before it." Browder v. Derwinski, 1 Vet.App.204, 205 (1991) The Board's review of the record prior to or after the Board decision of April 1991 shows no communication from the veteran or anyone acting on his behalf which indicates an intent to apply for a total disability rating based on unemployability. Rather, all such communications clearly state that the benefit sought is increased service-connected disability benefits. In the absence of evidence establishing the submission of an informal claim for a total disability rating based on unemployability prior to receipt of the veteran's formal application on March 7, 1994, the Board finds that the date of receipt of that claim is March 7, 1994. ] It is further argued that the veteran is entitled to an earlier effective date for the assignment of a schedular evaluation of 100 percent under the provisions of 38 U.S.C.A. § 5110(b)(2); under the provisions of 38 C.F.R. §§ 3.157(b)(1) and 3.400(q)(1)(i); under VAOPGCPREC 12-98; and under the holdings of the Court in Servello v. Derwinski, 3 Vet. App. 196, 198 (1992). However, 38 U.S.C.A. § 5110(b)(2) provides that the earliest effective date of an award of increased compensation shall be the earliest date as of which it was ascertainable that an increase in disability had occurred, if application was received within one year from such date. The implementing regulation, 38 C.F.R. § 3.400(o)(2), states that the effective date of an increase in disability compensation shall be the earliest date as of which it is factually ascertainable that an increase in disability had occurred if [the] claim is received within one year from such date. In this case, the record includes no evidence dated within one year prior to receipt of his reopened claim on May 31, 1991 showing an increase in the severity of the veteran's service-connected PTSD. In fact, the veteran has submitted no evidence which reflects treatment for his PTSD within one year prior to receipt of his reopened claim on May 31, 1991, and no such evidence is cited or referenced in support of that argument. With respect to the arguments propounded under 38 C.F.R. §§ 3.157(b)(1) and Servello v. Derwinski, 3 Vet. App. 196, 198 (1992), the record contains no report of VA examination or hospitalization, no evidence from a private physician or layman, or State or other institution record dated or received within one year prior to receipt of the veteran's claim on May 31, 1991. According, that regulation and the Court's holding interpreting that regulation have no application in the instant appeal. As to the application of 38 C.F.R. § 3.400(q)(1)(i), as interpreted by VAOPGCPREC 12-98, the record shows that the first written communication received subsequent to issuance of the final Board decision of April 1991 was the veteran's Statement in Support of Claim (VA Form 21-4138), received at the RO on May 31, 1991. That document was accepted as a claim for increase, and the date of receipt of that document was accepted as the date of the veteran's reopened claim. Thereafter, all additional evidence received prior to expiration of the appeal period and prior to this appellate decision was accepted as pertaining to and in support of the veteran's claim for increase, including the maximum benefit available, and, following receipt of his VA Form 21-8940 at the RO on March 7, 1994, his claim for a total disability rating based on unemployability due to service-connected disability. Accordingly, arguments for an earlier effective date based upon the alleged failure to consider and apply 38 C.F.R. § 3.400(q)(1)(i) and VAOPGCPREC 12-98 are without merit. While the veteran has submitted medical evidence which includes a Report of Attending Physician, completed by a physician at the VA Center for Stress Recovery in February 1986, a May 1987 Statement of Disability by a VA psychologist, and additional medical evidence that addresses the extent of his disability from various causes, that evidence does not pertain to the degree or severity of the veteran's PTSD or his entitlement to a total rating based on unemployability since the dates of the claims which are the subject of this appeal or within one year prior to those claims. ] For the reasons and bases explained above, the Board finds that neither that particular evidence nor any evidence submitted since the date of the veteran's reopened claim establishes that a rating in excess of 50 percent for PTSD was warranted during that period or at any time prior to the date of the VA psychiatric examination conducted on June 5, 1998. Accordingly, the assignment of a 100 schedular rating for PTSD effective June 5, 1998, is affirmed, and the appeal for a rating in excess of 50 percent prior to that date is denied. In addition, the Board finds that the medical and other evidence submitted in support of the veteran's claims does not demonstrate that he was unemployable due to service- connected disability, or that vocational rehabilitation was infeasible, prior to June 5, 1998, nor was there evidence of circumstances which the appropriate officials might find so "exceptional or unusual" as to warrant an extraschedular rating prior to that date. Shipwash v. Brown, 8 Vet. App. 218, 227 (1995). Further, the Board finds that the evidentiary record since the date of the veteran's reopened claim for a rating in excess of 50 percent in May 1991, including the period since the filing of his application for a total disability rating based on unemployability due to service-connected disability (VA Form 21-8940) on March 7, 1994, does not establish that the veteran was unemployable due to service-connected disability at any time during the period from May31, 1991 until June 5, 1998, when unemployability due to PTSD was first clinically demonstrated. In reaching its decisions, the Board has considered the doctrine of reasonable doubt, however, as the preponderance of the evidence is against the appellant's claims, the doctrine is not for application. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). ORDER Entitlement to an effective date prior to June 5, 1998, for a rating in excess of 50 percent for PTSD is denied Entitlement to a total disability rating based on unemployability due to service-connected disability during the period from May 31, 1991 to June 5, 1998, is denied. F. JUDGE FLOWERS Member, Board of Veterans' Appeals