Citation Nr: 0004077 Decision Date: 02/16/00 Archive Date: 02/23/00 DOCKET NO. 96-02 179 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Seattle, Washington THE ISSUE Entitlement to an increased evaluation for post-traumatic stress disorder (PTSD), currently evaluated as 30 percent disabling. REPRESENTATION Veteran represented by: The American Legion WITNESS AT HEARING ON APPEAL The veteran ATTORNEY FOR THE BOARD M.S. Lane, Associate Counsel INTRODUCTION The veteran served on active duty from February 1964 until February 1967. Service in Vietnam is indicated by the record. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a January 1995 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO), located in Seattle, Washington, which denied entitlement to a rating in excess of 10 percent for PTSD. During the pendency of this appeal, the RO granted an increased disability rating of 30 percent for the veteran's PTSD. In AB v. Brown, 6 Vet. App. 35 (1993), the United States Court of Appeals for Veterans Claims (the Court) held that on a claim for an original or increased rating, the veteran 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 benefit available is awarded. In this case, the veteran has continued to express disagreement with the disability rating assigned. In January 1996, the veteran testified at a personal hearing held at the RO. The transcript of the hearing is associated with the veteran's claims folder. FINDING OF FACT The veteran's PTSD is manifested by occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks due to symptoms such as nightmares, chronic sleep impairment, and mild memory loss; although the veteran appears to be generally functioning satisfactorily, with routine behavior, self-care, and conversation shown to be normal. CONCLUSION OF LAW The schedular criteria for a rating in excess of 30 percent for PTSD have not been met. 38 U.S.C.A. § 1155 (West 1991); 38 C.F.R. § 4.130, Diagnostic Code 9411 (1999); 38 C.F.R. § 4.132, Diagnostic Code 9411 (1996). REASONS AND BASES FOR FINDING AND CONCLUSION The veteran is seeking an increased disability rating for his service-connected PTSD. In the interest of clarity, the Board will review the law, VA regulations and other authority which may be relevant to this claim; describe the factual background of this case; and then proceed to analyze the claim and render a decision. Relevant law and regulations Disability evaluations are determined by the application of VA's Schedule for Rating Disabilities (Schedule), 38 C.F.R. Part 4 (1999). The Schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of or incident to military service. The percentage ratings represent, as far as practicably can be determined, the average impairment in earning capacity resulting from such diseases and injuries and the residual conditions in civil occupations. 38 U.S.C.A. § 1155; 38 C.F.R. § 4.1 (1999). In determining the disability evaluation, the VA has a duty to acknowledge and consider all regulations which are potentially applicable based upon the assertions and issues raised in the record and to explain the reasons and bases for its conclusion. Schafrath v. Derwinski, 1 Vet. App. 589, 592 (1991). Governing regulations to include 38 C.F.R. §§ 4.1, 4.2 (1999) require evaluation of the complete medical history of the veteran's condition. Where entitlement to compensation has already been established and an increase in the disability rating is at issue, such as in the present case, the present level of disability is of primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). 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 for that rating. Otherwise the lower rating will be assigned. 38 C.F.R. § 4.7 (1999). All benefit of the doubt will be resolved in the veteran's favor. 38 C.F.R. § 4.3 (1999). The veteran filed his claim of entitlement to an increased rating for PTSD in April 1994. Effective November 7, 1996, during the pendency of this appeal, the VA's Schedule, 38 C.F.R. Part 4, was amended with regard to rating mental disorders including PTSD. 61 Fed. Reg. 52695 (Oct. 8, 1996) (codified at 38 C.F.R. § 4.130). Because the veteran's claim was filed before the regulatory change occurred, he is entitled to application of the version most favorable to him. See Karnas v. Derwinski, 1 Vet. App. 308, 311 (1991). In this case, the RO advised the veteran of both the old and revised regulations. Accordingly, the Board finds that it may proceed with a decision on the merits of the veteran's claim, with consideration of the original and revised regulations, without prejudice to the veteran. See Bernard v. Brown, 4 Vet. App. 384, 393-394 (1993). Before November 7, 1996, the VA Schedule read as follows: General Rating Formula for Psychoneurotic Disorders: 100% The attitudes of all contacts except the most intimate are so adversely affected as to result in virtual isolation in the community. Totally incapacitating psychoneurotic symptoms bordering on gross repudiation of reality with disturbed thought or behavioral processes associated with almost all daily activities such as fantasy, confusion, panic and explosions of aggressive energy resulting in profound retreat from mature behavior. Demonstrably unable to obtain or retain employment. 70% Ability to establish and maintain effective or favorable relationships with people is severely impaired. The psychoneurotic symptoms are of such severity and persistence that there is severe impairment in the ability to obtain or retain employment. 50% Ability to establish or maintain effective or favorable relationships with people is considerably impaired. By reason of psychoneurotic symptoms the reliability, flexibility and efficiency levels are so reduced as to result in considerable industrial impairment. 30% Definite impairment in the ability to establish or maintain effective and wholesome relationships with people, with psychoneurotic symptoms resulting in such reduction in initiative, flexibility, efficiency, and reliability levels as to produce definite industrial impairment. 38 C.F.R. § 4.132, Diagnostic Code 9411 (1996). On or after November 7, 1996, the VA Schedule for rating PTSD reads as follows: 100% 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. 70% Occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near- continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a worklike setting); inability to establish and maintain effective relationships. 50% 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 effective work and social relationships. 30% Occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as: depressed mood, anxiety, suspiciousness, panic attacks (weekly or less often), chronic sleep impairment, and mild memory loss (such as forgetting names, directions, recent events). 38 C.F.R. § 4.130, Diagnostic Code 9411 (1999). Factual Background In September 1979, the veteran was treated by Dr. W.C., a private physician, for various symptoms, including suspiciousness, delusions, and auditory hallucinations. Dr. W.C. indicated that due to his symptoms, the veteran had become unable to perform his usual work duties. Following examination, Dr. W.C. diagnosed the veteran with paranoid schizophrenia and concluded that it was doubtful that the veteran would ever be able to work again. Private treatment records and hospitalization reports dated from March 1981 through April 1988, reflect ongoing treatment for schizophrenia. These treatment reports note the veteran's continuing unemployment, isolative behavior, poor living conditions, poor hygiene, divorced status and inability to care for himself. Social Security Administration records reflect that the veteran was awarded disability benefits from that agency for several disabilities, including paranoid schizophrenia, chronic schizophrenia, undifferentiated type, and "Agent Orange." In December 1989, a VA social and industrial survey was conducted. The VA social worker noted the veteran's history of paranoid schizophrenia for the previous 20 years. The veteran indicated that he was first hospitalized for a psychiatric disorder in 1969, followed by other periods of hospitalization. He stated that for the past year he had no longer been experiencing the hallucinations that he had experienced almost continuously in the past, and that his overall condition had significantly improved. He reported that he had been unemployed since 1979. The veteran also reported difficulty sleeping and that he had been experiencing dreams of being captured and of being in combat situations. In December 1989, the veteran was provided with a VA psychiatric examination. The VA examiner noted that this was a difficult case in which to provide an opinion because the veteran had both a clear history of paranoid schizophrenia and a history consistent with PTSD. The examiner diagnosed schizophrenia and "PTSD, delayed, in part masked by major psychotic disorder." The examiner stated that the veteran had been improving somewhat and that his major psychotic disorder had cleared. The VA examiner also concluded that the veteran's PTSD was clearly recognizable and that he would find the veteran "100% percent disabled for PTSD." In May 1992, the veteran underwent a VA psychiatric evaluation. The veteran reported that he was engaged and had been living in a house with his fiancée for the past two years. He also reported that he had been taking trips, engaging in activities, and visiting with relatives. He indicated that he had worked for two months as a pipefitter in 1990 and 1991, but stated that he was not allowed to work more than that or his benefits would be cut off. He reported that he had intrusive thoughts about Vietnam maybe five times a month, but not as often as he had experienced in the past. He stated that he had flashback experiences, that his startle response was still terrible, and that his hypervigilance was not as bad as it used to be. On examination, the VA examiner noted that the veteran had good hygiene and grooming. The VA examiner also noted that he exhibited flattened affect and was reportedly happy one day and sad the next. He was also found to be alert and oriented, with no delusional thinking, and no hallucinations. Insight and judgment were reportedly fair, and recent and remote memory and recall were found to be grossly intact. The examiner diagnosed the veteran with PTSD and chronic residual schizophrenia. Private medical treatment records dated between September 1994 and January 1995 reflect that the veteran did not appear suicidal during this period and that his symptoms were being controlled with medicine. In January 1995, an examiner indicated that the veteran's diagnosis was not clear and noted questionable schizoaffective disorder and questionable PTSD. In November 1994, the veteran underwent a VA psychiatric examination. He reported that he was living in a mobile home, which he also rented to roommates. He indicated that he had not worked steadily since 1980 when he was working as a pipefitter. The VA examiner noted the veteran's past diagnoses of chronic, undifferentiated schizophrenia and PTSD. The VA examiner also noted that the veteran's symptoms of schizophrenia had included active hallucinations, threatening behavior, and paranoid delusions. The veteran described himself as having no motivation to work more steadily. He stated that his sleep disturbance limited his ability to work and that he took naps during the day. He reported that he enjoyed certain activities and had a lot of friends. He described no anger or temper problems and no overt hyper vigilance. He reported reduced concentration and indicated that he startled easily, particularly with loud noises and machine gun-like noises. He stated that he continued to have nightmares about being captured perhaps one or two times per month, and that he would often awaken scared and tired the next day. The VA examiner noted that he denied any current significant depression, suicidal thoughts, or active hallucinations. On examination, the VA examiner noted that the veteran was casually groomed, and neatly dressed, with a very restricted and flat affect. His thought process was found to be generally coherent, though at times somewhat tangential. He was reportedly alert and oriented times three, with grossly intact memory and concentration. There were no acute suicidal or homicidal thoughts found, and his mood was noted to be euthymic. The VA examiner found that he did not have any significant paranoia, depression, or anxiety. The veteran's abstraction ability was found to be grossly intact and insight and judgment were reportedly fair. The examiner diagnosed the veteran with chronic schizophrenia, undifferentiated and PTSD, with residual symptoms. The VA examiner assigned a Global Assessment of Functioning score of 35. The VA examiner concluded that the veteran had residual symptoms of schizophrenia and PTSD, and that his symptoms appeared to have improved since the early 1980's when he was hospitalized for active psychiatric symptomatology. In January 1996, the veteran testified at a personal hearing held at the RO. He stated that he usually got approximately six hours of sleep a night, but that it was often broken up so he would sleep for a couple of hours, awaken, and then wander around. He indicated that he had nightmares once every three months about events that happened in the service. He stated that he did not have any close friends that he communicated with anymore because he felt that people were taking advantage of him. He stated that he went to China recently, and did not have any problems with the people there and did not experience any nightmares bringing back memories from Vietnam. He stated that his recent marriage was going "real good." He stated that he would see his doctor for counseling approximately every three months, or sometimes more depending on how he was feeling. He described being in really bad shape in 1980 and working real hard to improve himself. He indicated that the doctors' reports stated that he had improved tremendously since that time. He reported that he was currently working part-time and receiving Social Security disability benefits. Private medical records dated between February 1996 and July 1997 reveal that the veteran was generally getting along well with his wife of one year, but that he sometimes got "mad real fast." He was noted to be doing well, and working in the morning delivering papers, which he liked. He indicated that he heard no voices since the 1980's. The veteran reported taking trips and picnics, and that he did the billing in his household and remembered addresses. The veteran indicated that he could not do algebra and trigonometry, which were required for pipefitting. He stated that he kept trying to relearn them, and would sometimes learn them temporarily, only to forget them later. An examiner provided an impression that the veteran was disabled in part due to atrophy of job skills and confidence. In June 1997, the veteran underwent a VA psychiatric examination. The veteran indicated that he had been experiencing a lot of bad dreams and fatigue, and that his sleep was often brief. He stated that he might go for two days with only three hours of sleep, and another day with seven or eight hours of sleep. He denied experiencing any nervousness, anxiety, paranoid thinking, or other symptoms. He indicated that he still had "bad thoughts" regarding Vietnam. He indicated that he was working part-time as a janitor, having started that job a couple of months earlier. He reported living in an apartment with his wife of two years. He indicated that he did household chores and general maintenance at the apartment. He reported hobbies, to include travel. He reported that he had many close friends and family in the area. He described his mental condition as "getting better" and noted that he did not get upset like he used to. During the examination, the VA examiner noted that the veteran had a somewhat blunted affect; a slight, intermittent hesitancy in his speech; and no current hallucinations. The veteran denied any problems with thinking or concentration, but indicated that he had difficulty with memory. The VA examiner indicated that the veteran continued to do reasonably well, and that his PTSD symptoms were very similar to those evaluated in November 1994. The VA examiner stated that the veteran's mood might be somewhat improved and that his overall functioning was perhaps slightly improved. The VA examiner stated that separating the veteran's symptoms of PTSD and schizophrenia and attributing them to a particular disorder was a difficult task. The examiner indicated that he believed the veteran was more disabled than perhaps a 10 percent rating would indicate, but stated that he was not familiar with the criteria and would hesitate to suggest more than a possible need for a somewhat higher rating in view of the total picture. The examiner diagnosed schizophrenic reaction, residual type, and PTSD, with residual symptoms. The examiner noted that the veteran's major PTSD symptomatology was sleep disturbance, chronic fatigue and intrusive recollections. The examiner assigned a GAF score of approximately 45-50. In August 1999, the veteran underwent another VA psychiatric examination. He reported that he was still married and working part-time. He reported that he slept an average of six hours per night, but that lately his sleep had been bad, as he would usually awaken three to four times a night. He reported weekly nightmares, but no flashbacks. He stated that he had almost daily thoughts of Vietnam. He was noted to be hypervigilant, mild to moderate. He described exaggerated startle response, particularly around the Fourth of July. He indicated that he liked to go out, but did not go out much because his wife was studying and his work at a golf and country club made going out to a restaurant less exciting. He indicated that he did not get angry. He stated that his concentration was somewhat affected. He reported having contact with friends and relatives, and a good relationship with his wife. He described his mood as "pretty much happy." He reported that that he had no psychotic symptoms recently. He stated that he no longer got any counseling. He indicated that he and his wife owned a condominium. The VA examiner described the veteran as very well groomed, pleasant, and cooperative. His thought flow was found to be linear with tight associations. The veteran reportedly denied any suicidal or homicidal ideation. The VA examiner stated that the veteran's general knowledge was adequate and that he was oriented as to time, place and person. Immediate memory was noted to be 3/3, recent memory to be 3/3, and remote memory was noted to be adequate. The VA examiner found that the veteran abstracted adequately, although somewhat concretely at times. His concentration was found to be acceptable and his insight and judgment were noted to be adequate. The VA examiner concluded that the veteran's condition seemed to have changed little since 1997. The VA examiner diagnosed PTSD, mild to moderate severity on a scale of mild, moderate, severe, and profound; and schizophrenia, residual type. The VA examiner assigned a GAF score of 62. Analysis Initial matter- well groundedness of the claim/duty to assist/standard of proof Initially, the Board concludes that the veteran's claim is well grounded within the meaning of the statutes and judicial construction. See 38 U.S.C.A. § 5107(a) (West 1991). When a veteran claims that he has suffered an increase in disability, or that the symptoms of his disability are more severe than is contemplated by the currently assigned rating, that claim is generally considered well grounded. Bruce v. West, 11 Vet. App. 405, 409 (1998); Proscelle v. Derwinski, 2 Vet. App. 629, 631-632 (1992). Upon the submission of a well-grounded claim, the VA has a duty to assist the veteran in developing the facts pertinent to his claim. 38 U.S.C.A. § 5107. In the instant case, there is ample medical and other evidence of record, the veteran has been provided with several recent VA examinations, and there is no indication that there are additional records that have not been obtained and which would be pertinent to the present claim. Thus, no further development is required in order to comply with VA's duty to assist as mandated by 38 U.S.C.A. § 5107(a). Once the evidence has been assembled, it is the Board's responsibility to evaluate the evidence. When there is an approximate balance of evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C.A. § 5107(b); 38 C.F.R. §§ 3.102, 4.3 (1999). In Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990), the Court stated that "a veteran need only demonstrate that there is an 'approximate balance of positive and negative evidence' in order to prevail." To deny a claim on its merits, the preponderance of the evidence must be against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996), citing Gilbert, 1 Vet. App. at 54. Discussion The veteran is currently rated as 30 percent disabled for his service-connected PTSD. As noted above, the Board will consider the veteran's claim under both the current and the former schedular criteria in accordance with the Court's ruling in Karnas, 1 Vet. App. at 311. Regarding the new criteria, the Board finds that the preponderance of the evidence is against an increased rating of 50 percent, as recent VA psychiatric examination has revealed no evidence of symptoms such as circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty understanding complex commands; impairment of short and long-term memory; impaired judgment; impaired abstract thinking; or disturbances of motivation and mood. In particular, the Board notes that the November 1994 VA examiner specifically found that the veteran's judgment was fair and that his abstraction was intact. Additionally, both the November 1994 and August 1999 VA examiners found the veteran's memory to be intact, and although the November 1994 VA examiner noted flattened affect, the June 1997 noted only blunted affect with continued improvement in the veteran's mood. The Board recognizes that the veteran has continued to report chronic sleep impairment and fatigue, as well as occasional nightmares related to Vietnam. He also specifically reported in June 1997 that he has continued to have some difficulty with his memory. However, his currently assigned 30 percent disability rating contemplates some mild symptoms such as chronic sleep impairment and mild memory loss. The evidence of record shows that the veteran and his wife currently own a condominium; that the veteran has been able to maintain consistent employment for several years; that he performs household chores and general maintenance; that he engages in hobbies and other activities; and that he has consistently presented himself on examination as well groomed and neatly dressed. In essence, the Board finds that these factors support the veteran's presently assigned 30 percent rating, which contemplates generally satisfactorily functioning, with self-care, routine behavior, and conversation shown to be normal. The Board further finds that in light of the veteran's mild symptomatology and generally satisfactorily functioning, the preponderance of the evidence is against an increased disability rating of 50 percent under the new criteria. The Board also finds that a rating of 70 percent is not warranted under the new criteria, as the recent competent and probative evidence of record does not demonstrate that the veteran experiences suicidal ideation; that he engages in obsessional rituals which interfere with routine activities; that he experiences near-continuous panic or depression, impaired impulse control, or spatial disorientation; or that he displays neglect of personal appearance and hygiene. In accordance with the Court's ruling in Karnas, the Board has also considered whether a 50 percent evaluation or higher is warranted for the veteran's PTSD under the old criteria. However, the Board believes that the more recent evidence of record does not demonstrate that the veteran is considerably impaired in his ability to maintain effective or favorable relationships with people, or that he experiences psychoneurotic symptoms causing his the reliability, flexibility and efficiency levels to be so reduced as to result in considerable industrial impairment. As noted above, the record demonstrates that the veteran's current PTSD symptoms consistent of no more than chronic sleep impairment, fatigue, and some mild memory loss. The record also shows that over the past several years, he has been able to maintain a good relationship with his wife, as well as with other family and friends. He has also reported that he has been able to maintain employment for the past several years and that he routinely engages in hobbies and other activities. For these reasons, the Board concludes that the preponderance of competent and probative evidence is against finding that the veteran's functioning is "considerably" impaired so as to warrant an increased disability rating of 50 percent under the old criteria. The Board wishes to note that it is cognizant that the veteran was hospitalized in past years for psychiatric problems and that the medical evidence of record reveals a general history of symptomatology much more severe than was demonstrated during the veteran's more recent VA psychiatric examinations. However, the Board also wishes to note that the veteran was primarily diagnosed with various forms of schizophrenia during such hospitalizations, for which many of his symptoms were attributed and for which he is not service- connected. Furthermore, the Board believes that the evidence of record shows that the veteran's overall psychiatric condition has improved steadily since the 1980's, demonstrating a general remission of his schizophrenia since December 1989, and only mild PTSD symptomatology thereafter. The Board further believes that this improvement in his condition has allowed the veteran to obtain and maintain ongoing employment in recent years, and to develop better relationships with his friends and family. The Board finds this conclusion to be consistent with the findings of both the November 1994 VA examiner, who specifically concluded that the veteran's symptoms had improved since the early 1980's, and the June 1997 VA examiner, who indicated that the veteran's mood and overall functioning had continued to improve following his November 1994 VA examination. The Board also finds that this is consistent with the veteran's GAF scores, which have continued to improve in recent years, going from 35 in 1994, which is reflective of major impairment in several areas, to 62 in 1999, which is indicative of only some mild symptoms or mild impairment in social or occupational functioning. The Board notes that these GAF scores account for impairment caused by both the veteran's PTSD and his non service- connected schizophrenia, which the Board believes to have been in remission for some time. In short, while the Board has considered the veteran's past history of hospitalizations and severe psychiatric symptomatology, the Board finds the more recent VA psychiatric examinations of record, which relate primarily to the veteran's PTSD rather than his non service-connected schizophrenia, to be much more probative in determining the present level of the his PTSD disability. See Francisco, 7 Vet. App. at 58. In summary, for the reasons and bases set forth above, the Board finds that the preponderance of the competent and probative evidence is against the assignment of a rating in excess of 30 percent under both the new and old criteria of Diagnostic Code 9411. Extraschedular rating The Court has held that the question of an extraschedular rating is a component of the veteran's claim for an increased rating. See Bagwell v. Brown, 9 Vet. App. 157 (1996). Bagwell stands for the proposition that the Board may deny extraschedular ratings, provided that adequate reasons and bases are articulated. See also VAOPGCPREC 6-96 (finding that the Board may deny extraschedular ratings, provided that the RO has fully adjudicated the issue and followed appropriate appellate procedure). Bagwell left intact, however, a prior holding in Floyd v. Brown, 9 Vet. App. 88, 95 (1996) which found that when an extraschedular grant may be in order, that issue must be referred to those "officials who possess the delegated authority to assign such a rating in the first instance," pursuant to 38 C.F.R. § 3.321 (1999). The Board notes that the RO, in the March 1998 Supplemental Statement of the Case, concluded that referral for an extraschedular evaluation was not warranted. The Board will, accordingly, consider the provisions of 38 C.F.R. § 3.321(b)(1) (1999). Ordinarily, the VA Schedule for Rating Disabilities will apply unless there are exceptional or unusual factors which would render application of the schedule impractical. See Fisher v. Principi, 4 Vet. App. 57, 60 (1993). According to the regulation, an extraschedular disability rating is warranted upon a finding that "the case presents such an exceptional or unusual disability picture with such related factors as marked interference with employment or frequent periods of hospitalization that would render impractical the application of the regular schedular standards." 38 C.F.R. § 3.321(b)(1) (1999). In this case, the Board finds that the evidence does not show that the veteran's service-connected PTSD disability presents such an exceptional or unusual disability picture as to render impractical the application of the regular schedular standards so as to warrant the assignment of an extraschedular rating under 38 C.F.R. 3.321(b)(1). Although the veteran appears to have experienced several periods of extended unemployment throughout the 1980's, the evidence of record demonstrates that he has been able to maintain consistent employment throughout the past several years. Furthermore, although several medical care providers in the 1980's specifically found that the veteran was unable to maintain employment, these opinions appear to have been provided solely in regard to the veteran's schizophrenia and not his service-connected PTSD. As discussed in detail above, the veteran's schizophrenia appears to have been in remission for some time. While the veteran continues to experience symptoms such as chronic sleep impairment and mild memory loss as a result of his service-connected PTSD, these symptoms have not prevented him from obtaining employment or from engaging in a variety of hobbies and other activities. In light of the veteran's recent employment and his continued improvement in functioning since the remission of his schizophrenia, the Board finds that the evidence does not demonstrate that his service-connected PTSD markedly interferes with his ability to secure or maintain employment. As discussed above, the veteran required hospitalization for psychiatric problems on several occasions in the 1980's. However, these hospitalizations likewise appear to have been solely for treatment related to the veteran's schizophrenia, which is not a service-connected disability. There is no indication that the veteran has ever required hospitalization for his service-connected PTSD disability, and no indication that he has required any hospitalization whatsoever for psychiatric problems in recent years. In summary, the Board finds that the evidence in this case does not demonstrate that the veteran's service-connected PSTD markedly interferes with his employment or that he has required frequent periods of hospitalization for this disability. Thus, the Board finds the evidence of record does not reflect any factor which takes the veteran outside of the norm, or which presents an exceptional or unusual disability picture. See Moyer v. Derwinski, 2 Vet. App. 289, 293 (1992); see also Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993) [noting that the disability rating itself is recognition that industrial capabilities are impaired]. Accordingly, the Board determines that the assignment of an extraschedular rating pursuant to 38 C.F.R. § 3.321(b)(1) is not warranted. ORDER Entitlement to an evaluation in excess of 30 percent for PTSD is denied. Barry F. Bohan Member, Board of Veterans' Appeals The Court of Veterans Appeals has stated the word "definite", as used in the old schedular criteria for a 30 percent evaluation, is a qualitative term rather than a quantitative term. Hood v. Brown, 4 Vet. App. 301, 303 (1993). However, the degree of impairment, which would lead to an award at the 30 percent level, can be quantified. Cox v. Brown, 6 Vet. App. 459, 461 (1994). In a precedent opinion, dated November 9, 1993, the VA General Counsel concluded that "definite" is to be construed as "distinct, unambiguous, and moderately large in degree." "Definite" represents a degree of social and industrial inadaptability that is "more than moderate but less than rather large." O.G.C. Prec. 9-93 (Nov. 9, 1993). VA, including the Board, is bound by this interpretation of the term "definite." 38 U.S.C.A. § 7104(c) (West 1991); 38 C.F.R. § 3.101 (1999). See Carpenter v. Brown, 8 Vet. App. 240, 242 (1995) [GAF is a scale reflecting the "psychological, social, and occupational functioning in a hypothetical continuum of mental health-illness." citing the American Psychiatric Association's DIAGNOSTIC AND STATISTICAL MANUAL FOR MENTAL DISORDERS (4th ed.), p.32.]. GAF scores ranging between 61 to 70 reflect some mild symptoms (e.g., depressed mood and mild insomnia) or some difficulty in social, occupational, or school functioning (e.g., occasional truancy, or theft within the household), but generally functioning pretty well, and has some meaningful interpersonal relationships. Scores ranging from 51 to 60 reflect moderate symptoms (e.g., flat affect and circumstantial speech, occasional panic attacks) or moderate difficulty in social, occupational, or school functioning (e.g., few friends, conflicts with peers or co-workers). Scores ranging from 41 to 50 reflect serious symptoms (e.g., suicidal ideation, severe obsessional rituals, frequent shoplifting) or any serious impairment in social, occupational or school functioning (e.g., no friends, unable to keep a job). Scores ranging from 31 to 40 reflect some impairment in reality testing or communication or major impairment in several areas, such as work or school, family relations, judgment, thinking, or mood.