Citation Nr: 0002898 Decision Date: 02/04/00 Archive Date: 02/10/00 DOCKET NO. 98-17 377 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Des Moines, Iowa THE ISSUES 1. Entitlement to service connection for prostate cancer due to exposure to ionizing radiation. 2. Entitlement to the assignment of higher disability ratings for post-traumatic stress disorder (PTSD), rated as 10 percent disabling from September 27, 1996, and 30 percent disabling from December 23, 1998. REPRESENTATION Appellant represented by: The American Legion WITNESSES AT HEARING ON APPEAL Appellant and spouse ATTORNEY FOR THE BOARD Jonathan B. Kramer, Associate Counsel INTRODUCTION The veteran had active service from June 1943 to January 1946. This case comes before the Board of Veterans' Appeals (Board) on appeal from a January 1998 rating decision rendered by the Department of Veterans Affairs (VA) Regional Office (RO) in Des Moines, Iowa, which denied service connection for prostate cancer and increased the veteran's disability rating for PTSD to 10 percent, effective September 27, 1996. The Board observes the veteran testified before the undersigned Board Member at an October 1999 Video Conference. During the pendency of this appeal, a June 1999 RO rating decision increased the veteran's PTSD disability rating to 30 percent. Inasmuch as the veteran has continued to express dissatisfaction with the 30 percent rating, has otherwise not withdrawn his appeal for an increased disability rating for his PTSD, and in light of the fact that the maximum schedular disability rating has not been assigned to date, the appeal continues. AB v. Brown, 6 Vet. App. 35, 38 (1993). FINDINGS OF FACT 1. There is no medical evidence of a nexus or link between the veteran's period of active duty service and his 1983 diagnosis of prostate cancer, to include as due to exposure to ionizing radiation. 2. For the period September 27, 1996 through December 22, 1998, service-connected PTSD is not shown to be productive of more than mild social and industrial impairment; or more than decreased occupational and social impairment only during times of stress, due to mild or transient symptoms. 3. For the period December 23, 1998 through February 16, 1999, the veteran's service-connected PTSD is not shown to be productive of more than definite social or industrial impairment; or more than occupational and social impairment, with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks. 4. Effective February 17, 1999, the veteran's service- connected PTSD is shown to be productive of symptoms of considerable social and industrial impairment; and occupational and social impairment, producing reduced reliability and productivity. CONCLUSIONS OF LAW 1. The veteran's claim of entitlement to service connection for prostate cancer due to exposure to ionizing radiation is not well grounded. 38 U.S.C.A. § 5107 (West 1991). 2. The schedular criteria for entitlement to a disability rating in excess of 10 percent for PTSD for the period September 27, 1996 to December 22, 1998, have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 4.1-4.14, 4.125-4.132, Diagnostic Code 9411 (1996); 38 C.F.R. §§ 4.125- 4.130, Diagnostic Codes 9411 (1999). 3. The schedular criteria for entitlement to a disability rating in excess of 30 percent for PTSD for the period December 23, 1998 to February 16, 1999, have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 4.1-4.14, 4.125-4.132, Diagnostic Code 9411 (1996); 38 C.F.R. §§ 4.125- 4.130, Diagnostic Codes 9411 (1999). 4. Effective February 17, 1999, the schedular criteria for a disability rating of 50 percent for PTSD have been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 4.1-4.14, 4.125-4.132, Diagnostic Code 9411 (1996); 38 C.F.R. §§ 4.125- 4.130, Diagnostic Codes 9411 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. Service connection for prostate cancer The veteran contends that he is entitled to service connection for prostate cancer on the basis that his February 1983 prostate cancer diagnosis (and resulting prostatectomy) was caused by exposure to ionizing radiation while serving in the forces occupying Nagasaki, Japan, shortly after the atomic bomb was detonated there. The law provides that an appellant is entitled to service connection for a disease or injury incurred or aggravated while in service. 38 U.S.C.A. § 1110 (West 1991); 38 C.F.R. § 3.303 (1999). That an injury occurred in service alone is not enough; there must be chronic disability resulting from that injury. If there is no showing of a resulting chronic condition during service, then a showing of continuity of symptomatology after service is required to support a finding of chronicity. 38 C.F.R. § 3.303(b). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Furthermore, where a veteran who served for ninety (90) days or more during a period of war (or during peacetime service after December 31, 1946) develops certain enumerated diseases specific to radiation-exposed veterans, such diseases may be presumed to have been incurred in service even though there is no evidence of such disease during the period of service. 38 U.S.C.A. § 1112(c) (West 1991); 38 C.F.R. § 3.309(d) (1999). This presumption is rebuttable by affirmative evidence to the contrary. See 38 U.S.C.A. §§ 1101, 1112, 1113, 1137 (West 1991); 38 C.F.R. §§ 3.307, 3.309 (1999). At the outset, the Board observes that prostate cancer is not a disease listed under 38 U.S.C.A. § 1112(c) and 38 C.F.R. § 3.309(d). Therefore, the Board finds that the veteran is not presumptively entitled to service connection for prostate cancer under these laws and regulations. At this point, the Board notes that prostate cancer is specifically addressed as a "radiogenic disease" that my be caused by exposure to ionizing radiation, pursuant to 38 C.F.R. § 3.311 (1999). However, before the Board may proceed to examine the merits of the veteran's claim, it must determine whether the veteran has submitted well-grounded claims as required by 38 U.S.C.A. § 5107(a). A well-grounded claim is one that is plausible, capable of substantiation or meritorious on its own. Murphy v. Derwinski, 1 Vet. App. 78, 81 (1990). While the claim need not be conclusive, it must be accompanied by supporting evidence. Tirpak v. Derwinski, 2 Vet. App. 609, 611 (1992). To establish that a claim for service connection is well grounded, there must be a medical diagnosis of a current disability; medical evidence, or in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and medical evidence of a nexus between the claimed in-service disease or injury and the present disease or injury. See Epps v. Gober, 126 F.3d 1464, 1467- 68(Fed. Cir. 1997); Caluza v. Brown, 7 Vet. App. 498, 506 (1995). Alternatively, the United States Court of Appeals for Veterans Claims (Court) has indicated that a claim may be well grounded based on application of the rule for chronicity and continuity of symptomatology, set forth in 38 C.F.R. § 3.303(b). See Savage v. Gober, 10 Vet. App. 488 (1997). The Court held that the chronicity provision applies where there is evidence, regardless of its date, which shows that an appellant had a chronic condition either in service or during an applicable presumption period and that the appellant still has such condition. That evidence must be medical, unless it relates to a condition that the Court has indicated may be attested to by lay observation. If the chronicity provision does not apply, a claim may still be well grounded "if the condition is observed during service or any applicable presumption period, continuity of symptomatology is demonstrated thereafter, and competent evidence relates the present condition to that symptomatology." Savage, 10 Vet. App. at 498. The veteran's service medical records (SMRs) are devoid of any evidence that the veteran complained of, was treated for, or diagnosed with, prostate cancer or any disease affecting the prostate gland. Post-service medical records show that in February 1983, the veteran was diagnosed with adenocarcinoma of the prostate and underwent a radical retropubic prostatectomy. As noted previously, claims of service connection based upon exposure to ionizing radiation are also governed by 38 C.F.R. § 3.311 (1999), which, in pertinent part, specifically defines prostate cancer as a "radiogenic disease", provided it is manifested five years or more after exposure to ionizing radiation. 38 C.F.R. § 3.311 (b)(2)(xxiii), (b)(5)(iv). When presented with a claim for service connection for a radiogenic disease, 38 C.F.R. § 3.311 requires, in summary, a determination of whether a veteran has been exposed to ionizing radiation, and data concerning the size and nature of the radiation dose must be requested from the appropriate office of the Department of Defense, after which the claim must be reviewed by the Under Secretary for Benefits, who is charged with making a determination as to whether the veteran's disease was the result of exposure to radiation in service. See 38 C.F.R. § 3.311. A review of the record reveals that the RO conformed to the requirements of 38 C.F.R. § 3.311 in developing the veteran's claim. In a December 1998 letter from the Defense Threat Reduction Agency (DTRA) to the RO, it is stated that the veteran's participation with occupation forces of Nagasaki was confirmed. The DTRA determined that the maximum possible dose received by the veteran during his service in Nagasaki was less than one rem. The DTRA further commented that [t]his does not mean that any individual approached that level of exposure. In fact, it is probable that the great majority of servicemen assigned to the Hiroshima and Nagasaki occupation forces received no radiation exposure whatsoever, and that the highest dose received by anyone was few tens of a millirem. The RO then referred this matter to the Under Secretary of Health in February 1999, for a medical opinion. Later that month, the Under Secretary of Health released a medical opinion stating that "[t]he sensitivity of the prostate to radiation carcinogenesis appears to be relatively low and not clearly established..." In light of the foregoing, it was opined that "it is unlikely that the veteran's prostate cancer can be attributed to exposure to ionizing radiation in service." The veteran is not precluded from establishing, by independent medical evidence, that a current disorder is etiologically related to exposure to radiation in service. See Combee v. Brown, 34 F.3d 1039 (Fed. Cir. 1994); 38 C.F.R. §§ 3.303(d); 3.311(b)(4). However, the claims file contains no medical evidence linking the veteran's diagnosed prostate cancer, and resultant removal of the prostate, to in-service exposure to ionizing radiation. As has already been noted, the medical evidence of record indicates only that it is unlikely that the veteran's prostate cancer is etiologically linked to ionizing radiation exposure during service. Without medical evidence linking the veteran's current disability to service, the veteran's claim for service connection for prostate in this case is not well grounded. Therefore, the only evidence of record to support the veteran's claims of service connection for prostate cancer, as a result of exposure to ionizing radiation or otherwise, is the October 1999 Video Conference testimony presented by the veteran and his wife, as well as the variously dated written statements of the veteran, his family, and acquaintances. However, as a matter of law, these statements do not satisfy the medical nexus requirement and cannot, therefore, render his claim well grounded. See Espiritu v. Derwinski, 2 Vet. App. 492, 494-95 (1992) (holding that laypersons are not competent to offer medical opinions). In other words, what is needed is medical evidence showing that his current disability is related to service. By this decision, the Board is informing the veteran that evidence of medical causation is required to render his claim well grounded. 38 U.S.C.A. § 5107(a); Robinette v. Brown, 8 Vet. App. 69 (1995). II. PTSD increased rating claim A person who submits a claim for benefits under a law administered by VA shall have the burden of submitting evidence sufficient to justify a belief by a fair and impartial individual that the claim is well grounded. See 38 U.S.C.A. § 5107(a). The Court has held that a mere allegation that a service-connected disability has become more severe is sufficient to establish a well-grounded claim for a higher disability rating. See Caffrey v. Brown, 6 Vet. App. 377, 381 (1994); Proscelle v. Derwinski, 2 Vet. App 629, 632 (1992). Accordingly, the Board finds that the veteran's claim for a higher disability rating is "well grounded" within the meaning of 38 U.S.C.A. § 5107(a). Once a claimant has presented a well-grounded claim, VA has a duty to assist the claimant in developing facts that are pertinent to the claim. See 38 U.S.C.A. § 5107(a). The evidence of record includes the veteran's service medical records, VA examination reports, VA treatment records, private medical records, and the veteran's Video Conference testimony and written statements. The Board finds that all relevant facts have been properly developed, and that all evidence necessary for an equitable resolution of the issue on appeal has been obtained. Therefore, no further assistance to the veteran with the development of evidence is required. Pursuant to a March 1997 RO rating decision, the veteran was initially granted service connection for PTSD and assigned a noncompensable disability rating, effective September 27, 1996. In January 1998, the RO rendered a rating decision increasing the veteran's disability rating to 10 percent, effective September 27, 1996. In accordance with a June 1999 rating decision, the veteran's disability rating was increased to 30 percent, effective December 23, 1998, which has remained in effect ever since. A March 1997 VA PTSD examination report stated that the veteran appeared preoccupied, but he was pleasant, polite, and friendly. Speech was coherent and relevant. He was oriented to time, place, and person, memory was intact, and there was no evidence of thought disorder, or suicidal or homicidal ideation. The veteran denied depression at the time of examination, but he complained of flashbacks and occasional nightmares of his wartime experiences. The diagnosis was PTSD associated with combat duties during World War II, which appeared to be in partial or social remission. There were some residual symptoms of occasional sleep disturbance, nightmares, and flashbacks. His global assessment of functioning score (GAF) was 70. An August 1997 VA examination report recounted the veteran's complaints of having daily intrusive thoughts, which was aggravated by the recent 50th anniversary of the atomic bombing in Japan. The veteran also complained of disturbed sleep due to nightmares, some symptoms of exaggerated startle response, and some irritability and anger. The examiner noted that the veteran has been able to maintain good relationships with his wife, children, and grandchildren. Objectively, the veteran was casually attired and kempt in appearance. Speech was logical and goal oriented, but his mood was dysphoric and accompanied by tearfulness. Psychomotor activity was slightly increased. The diagnoses included the following: major depressive disorder, resolved; PTSD, mild to moderate, chronic; cluster C traits with perfectionist quality; and a GAF of 66. The examiner further opined that the veteran appeared to have had PTSD symptoms dating back to the mid to late 1940's, but that symptoms were minimal until recently. VA clinical records for the period September 1998 to February 1999 show the veteran suffered from symptoms of insomnia, sleep disturbance, nightmares, anxiety, depression, fatigue, flashbacks, intrusive thoughts, and thoughts of suicide. A February 1999 outpatient clinical record revealed that the veteran was clean and well groomed, made good eye contact, was cooperative, and spoke coherently. He was tearful and emotional, affect was depressed, and mood was irritable and grouchy. The veteran complained of sleep disturbance, nightmares, suicidal ideation, and poor memory. The impression was chronic PTSD, with secondary nonpsychotic, recurrent major depressive disorder. The GAF was 46. A March 1999 outpatient clinical record recited the veteran's complaints of having difficulty concentrating and continued sleep disturbance, although his depression had improved since the last visit. The impression was chronic PTSD, with secondary nonpsychotic, recurrent major depressive disorder. The GAF was 48. An April 1999 outpatient clinical record noted that the patient was doing "so-so", with complaints of continued sleep disturbance that was associated with morning depression. There was also some suicidal ideation noted. The impression was chronic PTSD, with secondary nonpsychotic, recurrent major depressive disorder. The GAF was 42. A May 1999 outpatient clinical record stated that the veteran avoided people, continued to have sleep disturbance and nightmares, but that his Prozac prescription has helped alleviate his symptoms. The impression was chronic PTSD, with secondary nonpsychotic, recurrent major depressive disorder. The GAF was 45. A May 1999 VA PTSD examination report noted that the veteran's claims file was reviewed by the examiner prior to the interview. The veteran was neatly dressed and groomed, and showed good attention and energy, answering questions in detail. but he presented as dysphoric and very depressed, making little eye contact. The veteran complained of worsening symptoms. Current medications were noted to be Trazadone, Prozac, and Buspar. The veteran stated that most of his activity was at his home, where he did chores around the house. He seldom went into town or socialized with others, besides his wife and family, and he preferred to avoid others, and large crowds in particular. The veteran complained of getting only 5 hours of restless sleep per night, with nightmares of his wartime experiences. He also stated he was easily upset or angered by small frustrations or setbacks, was often tearful, experiences some suicidal thoughts, and felt hopeless, sad, and out of control much of the time. Objectively, the veteran was depressed and tearful, but his speech was logical and there were no indications of hallucinations, delusions, or formal thought disorder. He was oriented times three and his memory and concentration appeared adequate. The examiner's impression was that the veteran has suffered from PTSD symptoms since World War II, with avoidance, reduced stress tolerance, sleep problems, nightmares, intrusive recall, reduced emotional recall, and depression. Anxiety appeared controlled due to his general isolation from the outside world, and his marriage was stable. His symptoms of depression were noted to have worsened recently, representing a secondary disorder arising from his PTSD, "so that the total social and industrial impairment due to mental disorders would be attributable to his service-connected disorder." The diagnoses were as follows: PTSD, chronic, with secondary major depressive disorder; cluster C personality traits; and a GAF score of 48. In August 1999, an outpatient clinical record reported that the veteran complained of keeping his emotions inside. While describing his emotional pain, the veteran was observed to be weeping, very distraught, and under a lot of stress. The impression was chronic PTSD, with secondary nonpsychotic, recurrent major depressive disorder. The GAF was 41. An October 1999 outpatient clinical record recounted the veteran's complaints of wanting to be left alone, and of suffering from flashbacks, sleep disturbance, nightmares, anxiety, and suicidal ideation. Objectively, the veteran was anxious, tense, suspicious, irritable, and dysphoric. He made good eye contact, speech was coherent and relevant, and there was some insight and judgment. The assessment was chronic PTSD, with secondary nonpsychotic, recurrent major depressive disorder. The GAF was 39. The Board has also considered the October 1999 Video Conference testimony presented by the veteran and his wife, as well as the variously dated written statements of the veteran, his family, and acquaintances, which contend that the veteran's symptoms resulting from PTSD are more severe than the current disability ratings suggest. Under the laws administered by VA, disability ratings are determined by applying the criteria set forth in VA's Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. See 38 U.S.C.A. § 1155; 38 C.F.R. § 4.1. The Board observes here that the Court has noted that, in a claim of disagreement with the initial rating assigned following a grant of service connection, separate ratings can be assigned for separate periods of time, based on the facts found. Fenderson v. West, 12 Vet. App. 119 (1999). The Board has carefully examined the entire record and finds that the separate disability ratings assigned for the veteran's PTSD by the RO accurately reflects the relative severity of his disability at any given time, consistent with the requirements of Fenderson. The veteran's PTSD is rated under Diagnostic Code 9411. The Board notes that by regulatory amendment effective November 7, 1996, substantive changes were made to the schedular criteria for evaluating psychiatric disorders, including PTSD. Where the law or regulations change while a case is pending, the version most favorable to the claimant applies, absent congressional intent to the contrary. See Karnas v. Derwinski, 1 Vet. App. 308, 312-313 (1991). As this case has been pending since March 1995, the veteran's claim the assignment of a higher disability rating for PTSD will be considered under the criteria in effect prior to and after November 7, 1996. Prior to November 7, 1996, a 10 percent disability rating for PTSD was for assignment when symptoms were "[l]ess than the criteria for 30 percent, with emotional tension or other evidence of anxiety productive of mild social and industrial impairment." A 30 percent disability rating for PTSD was for assignment when there was "[d]efinite impairment in the ability to establish or maintain effective and wholesome relationships with people. The psychoneurotic symptoms result in such reduction in initiative, flexibility, efficiency and reliability levels as to produce definite industrial impairment." A 50 percent disability rating for PTSD was for assignment when the "[a]bility 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." A 70 percent disability rating was for assignment when the "[a]bility to establish or 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 and retain employment." 38 C.F.R. § 4.132, Diagnostic Code 9411 (1996). In determining whether a 30 percent or 50 percent disability rating is appropriate, it is pertinent to note that, in Hood v. Brown, 4 Vet. App. 301 (1993), the United States Court of Veterans Appeals stated that the term "definite" in 38 C.F.R. § 4.132 (1996) was "qualitative" in character, where as the other terms were "quantitative" in character, and invited the Board to "construe" the term "definite" in a manner that would quantify the degree of impairment for the purposes of meeting the statutory requirement that the Board articulate "reasons and bases" for its decision. 38 U.S.C.A. § 7104(d)(1) (West 1991). In a precedent opinion, dated November 9, 1993, the General Counsel of VA concluded that the term "definite" is to be construed as "distinct, unambiguous, and moderately large in degree." It 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). The Board is bound by this interpretation of the term "definite." 38 U.S.C. § 7104(c) (West 1991). Under the revised schedular criteria, a 10 percent disability rating is for assignment when there is occupational and social impairment due to mild or transient symptoms which decrease work efficiency and the ability to perform occupational tasks only during times of stress, or when symptoms are controlled by continuous medication; a 30 percent disability rating is for assignment when there is 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, mild memory loss (such as forgetting names, directions, recent events). A 50 percent disability rating is for assignment for occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened effect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment in 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. A 70 percent rating is warranted when the disorder is characterized by 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. Finally, a 100 percent disability rating is warranted when there is 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. See 38 C.F.R. § 4.130, Diagnostic Code 9411. After a review of the medical evidence of record, the Board finds that the veteran's PTSD symptomatology had remained stable and commensurate with the assigned disability ratings of 10 percent for the period September 27, 1996 through December 22, 1998, and 30 percent for the period December 22, 1998, to February 16, 1999, but that since February 17, 1999, the medical evidence shows that the veteran's PTSD symptomatology has become more severe. In March 1997, the veteran's PTSD was evaluated to be in partial or social remission, accompanied by a GAF score of 70. In August 1997, the veteran's PTSD was characterized as chronic, but mild to moderate degree. His major depressive disorder was reported to be resolved, and his GAF was reported to be 66. The medical evidence does not show that the veteran's psychiatric state significantly changed from this level until February 17, 1999. According to the Diagnostic and Statistical Manual of Mental Disorders (4th ed. 1994) (hereinafter "DSM-IV"), a GAF of 61-70 indicates "[s]ome 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 household), but generally functioning pretty well, has some meaningful interpersonal relationships." Thus, as the veteran's symptoms at this time were characterized as being fairly mild, the Board finds that, under either the old or revised criteria of Diagnostic Code 9411, the PTSD symptoms exhibited by the veteran more closely approximate the 10 percent and 30 percent disability ratings assigned during the period September 27, 1996 through February 16, 1999. As of February 17, 1999, the medical evidence demonstrates that the PTSD symptoms exhibited by the veteran has worsened to a more chronically severe state. The veteran's GAF fluctuated between a high of 48 in February 1999 to low of the 39 in October 1999, which is the date of the most recent psychiatric evaluation of record. Pursuant to DSM-IV, a GAF of 41-50 indicates "[s]erious 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)." A GAF of 31-40 "[s]ome impairment in reality testing or communication (e.g., speech illogical at times, obscure, or irrelevant) OR major impairment in several areas, such as work or school, family relations, judgment thinking, or mood..." Indeed, the medical evidence of record between February 1999 and October 1999 generally shows that the veteran was becoming more depressed, irritable, frustrated, angry, anxious, and hopeless, as well as experiencing continued nightmares, flashbacks, intrusive thoughts, and social isolation. Therefore, effective February 17, 1999, the Board finds that the PTSD symptomatology exhibited by the veteran more closely approximates the criteria provided under Diagnostic Code 9411 for a 50 percent disability rating, under either the old or revised criteria. The Board has also considered whether the assignment of the next higher disability rating of 70 percent, under either the old or revised criteria, is appropriate. The Board finds, however, that the assignment of a 70 percent disability rating is not warranted, for the following reasons: although the veteran is socially isolated, he has been able to maintain a good relationship with his family; his speech has always been noted to be logical, coherent, and relevant; he has consistently maintained his personal appearance and hygiene; neither judgment nor thinking were ever noted to be significantly impaired; he has been able to perform chores around the house; he has never performed obsessional rituals; incidents of spatial disorientation been not been observed or reported; and the symptoms that are present are not productive of more than considerable social or industrial impairment. To summarize, in consideration of all of the evidence of record, and in conjunction with the application of the criteria listed under Diagnostic Code 9411, the Board concludes that the preponderance of the evidence is against the assignment of disability rating in excess of 10 percent, effective for the period September 27, 1996 through December 22, 1998, and a disability rating in excess of 30 percent, effective for the period December 23, 1998 through February 16, 1999. However, the Board finds that a disability rating of 50 percent is warranted, effective February 17, 1999. Finally, the Board finds, as did the RO, that the evidence of record does not present such "an exceptional or unusual disability picture as to render impractical the application of the regular rating schedule standards." 38 C.F.R. § 3.321(b)(1) (1999). In this regard, the Board has considered the history of the veteran's disability, the current clinical manifestations, and the effect this disability may have on the earning capacity of the veteran under 38 C.F.R. §§ 4.1, 4.2, and finds that there has been no showing by the veteran that his PTSD has resulted in marked interference with his employment or necessitated frequent periods of hospitalization. In the absence of such factors, the Board finds that the criteria for submission for assignment of an extraschedular rating under 38 C.F.R. § 3.321(b)(1) are not met. See Bagwell v. Brown, 9 Vet. App. 337 (1996); Shipwash v. Brown, 8 Vet. App. 218, 227 (1995). ORDER A well-grounded claim not having been submitted, service connection for prostate cancer is denied. A disability rating in excess of 10 percent, for the period September 27, 1996, to December 22, 1998, is denied. A disability rating in excess of 30 percent, for the period December 23, 1998 to February 16, 1999, is denied. A disability rating of 50 percent for PTSD is granted, effective February 17, 1999, subject to the governing laws and regulations concerning monetary benefits. BRUCE KANNEE Member, Board of Veterans' Appeals