Citation Nr: 0003978 Decision Date: 02/15/00 Archive Date: 02/23/00 DOCKET NO. 97-06 814A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Phoenix, Arizona THE ISSUES 1. Entitlement to an effective date earlier than September 1, 1995, for the assignment of a 70 percent evaluation for post-traumatic stress disorder (PTSD). 2. Entitlement to an effective date earlier than September 1, 1995, for the award of a total rating based upon individual unemployability due to service-connected disability. 3. Entitlement to an increased evaluation in excess of 70 percent for PTSD. REPRESENTATION Appellant represented by: R. Edward Bates, Esquire ATTORNEY FOR THE BOARD Amanda Blackmon, Counsel INTRODUCTION The appellant served on active duty from October 1965 to October 1968. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 1996 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO), which denied, inter alia, the appellant's claims seeking entitlement to an increased evaluation in excess of 50 percent for PTSD, and entitlement to a total rating based on individual unemployability due to service-connected disability. The appellant filed a notice of disagreement with these rating determinations in September 1996. A statement of the case, relevant to the issues of entitlement to an increased evaluation in excess of 50 percent for PTSD and entitlement to a total rating based on individual unemployability, was issued to the appellant in December 1996. The appellant filed a formal substantive appeal (VA Form 9) in December 1996, thereby perfecting his appeal in this matter. In a rating decision, dated in March 1997, the appellant was awarded temporary total disability ratings based on periods of hospitalization (from May 15, 1995 to August 31, 1995; from December 12, 1995 to January 31, 1996; and from May 14, 1996 to June 30, 1996), which exceeded 21 days in length. See 38 C.F.R. § 4.29 (1999). By that same rating decision, the appellant was awarded an increased evaluation for his service-connected PTSD from 50 percent to 70 percent, and was awarded a total rating based on individual unemployability, with September 1, 1995 assigned as one of the effective dates for each of these awards, following termination of the temporary total disability rating. The RO sent the appellant a letter to this effect in April 1997, along with a copy of the March 1997 rating decision and notice of his appellate rights. In a subsequently filed notice of disagreement, dated in April 1997, the appellant indicated disagreement with the effective date of September 1, 1995, as effectuated in the March 1997 rating decision. The Board broadly construes the April 1997 notice of disagreement as contesting the September 1, 1995 effective date assigned for both the PTSD disability rating and the total rating based on individual unemployability. See Collaro v. West, 136 F.3d 1304 (Fed.Cir. 1998); Buckley v. West, 12 Vet. App. 76, 83-84 (1998). The RO furnished a supplemental statement of the case, relevant to each of the effective date claims, in August 1997. The RO received the appellant's formal substantive appeal in August 1997. A supplemental statement of the case was thereafter issued in January 1999. With respect to the increased evaluation for the service- connected PTSD, awarded during the pendency of the appeal, the United States Court of Appeals for Veterans Claims (formerly the United States Court of Veterans Appeals prior to March 1, 1999 (hereinafter, "the Court")), has held that on a claim for an original or an increased rating, the appellant will generally be presumed to be seeking the maximum benefit allowed by law or regulations, and it follows that such a claim remains in controversy where less than the maximum benefit available is awarded. AB v. Brown, 6 Vet. App. 35, 38 (1993). The Court further held that, where a claimant has filed a notice of disagreement as to a 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 appeal. The Board observes that the RO also denied the appellant's claim seeking entitlement to special monthly compensation in a January 1996 rating decision. A notice of disagreement, which indicated that the appellant disputed this adverse determination, was received by the RO in September 1996; and a statement of the case, relevant to this issue, was furnished in October 1997. Since a substantive appeal with respect to the claim for special monthly compensation has not been received by the RO, this claim is not properly before the Board for appellant consideration. See, e.g., Fenderson v. West, 12 Vet. App. 119, 129-131 (1999). Finally, in August 1999, the appellant's representative forwarded further written argument in support of the appellant's claims, along with previously reviewed clinical reports in support of his contentions. A waiver of RO consideration of this evidence was provided. FINDINGS OF FACT 1. All available, relevant evidence necessary for an equitable disposition of the appellant's appeal has been obtained by the RO. 2. In a March 1993 rating decision, the RO denied an increased evaluation in excess of 50 percent for PTSD, and denied a total rating based on individual unemployability due to service-connected disability. No appeal was initiated, following the March 1993 notification letter, as to either of these adverse determinations. 3. By a rating decision of April 1994, the RO awarded a temporary total disability evaluation based on a period of hospitalization (from May 28, 1993 to July 31, 1993) for the service-connected PTSD pursuant to 38 C.F.R. § 4.29; but denied an increased evaluation in excess of 50 percent for PTSD, effective from August 1, 1993, the day following the termination of the temporary total rating. The appellant was informed of this decision by a VA letter of notification, dated in May 1994; however, he did not submit to the RO a notice of disagreement that disputed either the effective dates or the disability ratings assigned in the April 1994 rating decision. 4. In June 1995, the RO received from the appellant a new claim for an increased rating in excess of 50 percent for PTSD, and he also raised a new claim for a total rating based upon individual unemployability. These claims were denied in a June 1996 rating decision, which was timely appealed by the appellant. 5. In a March 1997 rating decision, the RO granted a temporary total disability evaluation based on a period of hospitalization (from May 15, 1995 to August 31, 1995) for the service-connected PTSD pursuant to 38 C.F.R. § 4.29; and awarded both an increased evaluation of 70 percent for PTSD and a total rating based upon individual unemployability, each assigned an effective date of September 1, 1995, following the termination of a temporary total rating. The appellant perfected a timely administrative appeal with respect to the assignment of the September 1, 1995, as the effective date for each of the rating awards. 6. In October 1997, the RO received a VA outpatient treatment record dated December 14, 1992, which was received prior to an appellate decision as to the June 1995 pending claims for increased compensation, and which relates to an evaluation of the service-connected PTSD. 7. It is not factually ascertainable that an increase in severity of the service-connected PTSD had occurred prior to December 14, 1992. 8. The evidence of record demonstrates that as of June 7, 1994, the appellant's clinical signs and manifestations of his service-connected PTSD are productive of total occupation and social impairment, result in virtual isolation in the community, and preclude the appellant for securing or following substantially gainful employment. CONCLUSIONS OF LAW 1. Resolving all reasonable doubt in favor of the appellant, the criteria for an effective date of June 7, 1994, for the assignment of a 70 percent evaluation for post-traumatic stress disorder have been met. 38 U.S.C.A. §§ 5107, 5110 (West 1991); 38 C.F.R. §§ 3.1(p), 3.151, 3.155, 3.156, 3.157, 3.160, 3.400 (1999). 2. Resolving all reasonable doubt in favor of the appellant, the criteria for an effective of June 7, 1994, for the award of a total rating based upon individual unemployability have been met. 38 U.S.C.A. §§ 5107, 5110 (West 1991); 38 C.F.R. §§ 3.1(p), 3.151, 3.155, 3.156, 3.157, 3.160, 3.400 (1999). 3. Resolving all reasonable doubt in favor of the appellant, the criteria for a 100 percent schedular evaluation for post- traumatic stress disorder have been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. §§ 4.3, 4.16(c), 4.132, Diagnostic Code 9411 (1996), and as amended by 38 C.F.R. § 4.130, Diagnostic Code 9411 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Board finds that the appellant's claims for an increased evaluation for post-traumatic stress disorder, and for earlier effective dates for the award of an increased rating for PTSD, and the award of individual unemployability benefits are well-grounded within the meaning of 38 U.S.C.A. § 5107(a). That is, the Board finds that he has presented claims which are plausible. See Murphy v. Derwinksi, 1 Vet. App. 629 (1992). The Board also satisfied that all relevant evidence is of record and that no further assistance to the appellant is required to comply with the VA's duty to assist as mandated by 38 U.S.C.A. § 5107(a). Factual Background Service connection for PTSD was established in February 1991. Evidence reviewed by the RO in conjunction with this rating determination included service medical records, VA medical examination reports and outpatient records, and the appellant's lay statements. Clinical records, dated from January 1987 to March 1987, were reviewed. The treatment reports show that the appellant was hospitalized in January 1987 following a suicide attempt. The appellant was evaluated with alcohol abuse, and depression in conjunction with this hospitalization. The clinical reports reflect that the appellant was referred for inpatient treatment in the ADTP program. He was subsequently hospitalized in a private medical facility in April 1987 following another suicide attempt by an overdose on prescribed medication. The appellant was referred for vocational rehabilitation following the April 1987 suicide attempt. The appellant was also seen intermittently for psychiatric evaluation in the mental health clinic. The appellant was hospitalized following a third suicide attempt in September 1990. The medical report noted a diagnostic impression of major depression with melancholia, PTSD, history of drug dependence, and alcohol dependence, in remission. These reports also reflect that the appellant was seen for individual psychiatric therapy. A January 1991 hospital report indicated that the appellant received inpatient treatment for symptoms of chronic depression, tension, persistent anticipatory anxiety, and combat nightmares. It was noted that the appellant completed the inpatient program with some progress noted, in that he appeared less isolated and depressed. At the time of his discharge, the appellant was maintained on a course of prescribed medication. It was the examiner's assessment that the appellant was competent, and that he was employable within limited stress environment. Long-term psychotherapy was recommended. The final diagnoses included PTSD; dysthymic disorder; and history of alcoholism. Based upon a review of this evidence, the RO granted service connection for PTSD in a February 1991 rating action. A 30 percent rating evaluation was assigned for this disability under Diagnostic Code 9411. Following notification of this decision, an administrative appeal was not filed. A September 1991 vocational evaluation report indicated that the appellant was determined to be capable of placement in an entry level position that required learning and performing light duty. It was noted that the appellant's physical limitations prevented work that required strenuous job demands. In his assessment, the examiner noted that the appellant exhibited adequate personal hygiene and appearance. During the course of the inpatient evaluation, the appellant functioned well with his peers and staff. His general disposition was noted to be pleasant. The examiner recommended that the appellant participate in a three month adjustment training program to determine his work stamina as a prerequisite to vocational rehabilitation. At that time, the appellant's prognosis for full time employment was guarded. In November 1991, the appellant sought an increased evaluation for his service-connected PTSD condition. He indicated that his symptoms had increased in severity since he initiated outpatient treatment. He indicated that the effect of the intensive therapy program caused his symptoms to increase in severity. In particular, he noted that a lot of his memories concerning the events which occurred in Vietnam were brought to the surface and, as a result, his nightmares and intrusive thoughts had increased considerably. He reported that he continued to receive individual and group therapy weekly. The appellant indicated that he also experienced physical impairment to such an extent that his chances of employment were hindered. In a February 1992 rating decision, the RO granted an increased evaluation from 30 percent to 50 percent based upon a finding of considerable industrial impairment as a result of the appellant's service-connected PTSD. Following notification of this decision, an administrative appeal was not filed. In March 1992, the appellant was admitted to a VA hospital. He presented with complaints of increased symptoms of depression, including anhedonia, decreased energy level, insomnia, a 20 pound weight loss over the preceding one year period, increased cognitive difficulties, and suicidal ideation. The appellant also reported Vietnam-related nightmares, and recollections of violent experiences in Vietnam, and marital problems. During the course of this admission, the appellant was treated with electroconvulsive therapy (ECT), with some response. It was noted that this treatment course was followed because of the appellant's bleak clinical status, together with suicidal ideation and severe history of suicide attempts. This treatment course was discontinued sometime later due to a lack of major response after multiple treatments. The final diagnosis was major depression, recurrent; PTSD; marijuana abuse (Axis I). A Global Assessment of Functioning Scale score of "60 to 70" was indicated. In May 1992, the RO granted temporary total disability evaluation based upon this period hospitalization, with the previously assigned 50 percent evaluation reinstated. In August 1992, the appellant filed a formal claim for increased compensation based upon unemployability. The appellant reported that he was rendered unemployable in March 1990 due to his PTSD. The appellant indicated that he was last employed in 1989, and reported previous employment as a block layer and service person. He reported that he had completed high school, and received specialized training during service in vehicle maintenance. The appellant reported that he had been laid off from work due to his PTSD, which "induced poor performance in the summer of 1991." He noted that an eligibility evaluation in conjunction with vocational rehabilitation revealed that he was unable to begin work study. In support of this claim, clinical records, dated from January 1992 to November 1992, were reviewed. These treatment reports reflect that the appellant was seen in January 1992 for continued complaints of depression. He was evaluated with depression and PTSD. It was noted that the appellant had undergone his final hypnotherapy session, as it was believed that he had attained the maximum benefit. The appellant was noted to be stable, and reported that he was doing well when examined later that month. In March 1992, the appellant presented with suicidal intention and depression. He was referred to the mental health clinic for assessment. On evaluation, the appellant was evaluated with major depressive episode. The appellant was admitted for treatment of his symptoms. The hospital report referenced a final diagnosis of PTSD and depression. The appellant was evaluated with depression in May 1992, and was noted to be stable on his current course of medication. The treatment plan of therapeutic counseling was continued. In June 1992, the appellant was evaluated for symptoms of increased nightmares, flashbacks, isolation, and anger and aggression. On mental status examination, there was no evidence of psychosis, or suicidal or homicidal ideation. The appellant was noted to have a constricted mood and affect. Upon hospital discharge, the appellant has significantly improved and was continued on medication. The Axis I diagnosis was of PTSD. A GAF score ranging from 70 to 80 was entered. A September 1992 medical statement from the clinical coordinator of the veterans' treatment program indicated that the appellant continued to suffer from chronic severe PTSD. It was noted that since the previous (January 1992) report, the appellant had been twice hospitalized. It was also noted that the appellant had separated from his wife. In his assessment, the social worker evaluated the appellant with chronic severe PTSD, which was noted to result in severe impairment of marital, social and occupational functioning. When seen in November 1992, the appellant was evaluated with residual depression following recent ECT, and follow-up with anti-depressant medication. The clinical report indicated that the appellant exhibited a stable mood, with no abnormal thinking. A clinical assessment of major depression was indicated. During an evaluation later that month, the appellant reported increasing anxiety, and sleep disturbance. It was noted that he was fearful of the impending anniversary of his Vietnam service. Examination revealed symptoms of anxiety. The diagnostic impression was of PTSD. In March 1993, a claim for an increased rating for the service-connected PTSD was filed. It was noted that the appellant's symptomatology had increased in severity. The RO, in a March 1993 rating decision, denied the appellant's claim for an increased evaluation in excess of 50 percent for PTSD. This determination was predicated upon the RO's finding that the evidence did not demonstrate more than considerable impairment in his industrial adaptability. By that same rating decision, the appellant's claim for a total rating based upon individual unemployability was denied, based upon the RO's finding that the appellant did not meet the schedular requirements for individual unemployability. It was further noted that the evidence did not demonstrate that the appellant was precluded from obtaining substantially gainful employment. The appellant was informed of these adverse determinations later in March 1993, but he did not file a notice of disagreement. Accordingly, the determinations in the March 1993 rating decision constitute finally adjudicated claims for the purpose of this appeal. 38 U.S.C.A. § 7105(a)-(c) (West 1991); 38 C.F.R. §§ 3.104. 3.160(d) (1999). The appellant was hospitalized at VA facility from May to July 1993. The hospital report indicated that he presented with complaints of increased PTSD symptoms, to include isolation, nightmares, anger, and depression. The appellant related the onset of his increased symptoms to his son's arrival to live with him. The appellant was noted to report increased thoughts of suicide at the time of his admission. On mental status examination, the appellant exhibited depressed mood, with a consistent affect. There was no evidence of psychosis, or positive suicidal ideation following admission. During this hospital course, the appellant was treated with a trial of monoamine oxidase inhibitor, with the dosage subsequently increased to therapeutic level, in light of his failure on multiple prior medications. The appellant showed a gradual improvement in his mood and affect. It was noted that the appellant exhibited difficulty with insomnia throughout this hospitalization, which was not relieved with medication, but improved when medication to treat this symptom was discontinued. Upon discharge in July 1993, the appellant was prescribed medication, and follow-up therapeutic counseling was recommended. The Axis I diagnoses were of PTSD, and major depression with melancholia. A GAF score range of 40 to 50 was indicated. In April 1994, the RO entered a rating decision that denied the appellant's claim for an increased evaluation in excess of 50 percent for the service-connected PTSD condition, following termination of the temporary total disability rating that was awarded based upon the VA hospitalization from May to July 1993. The appellant was notified of each of the rating determinations and of his appellate rights in May 1994, but he did not initiate an administrative appeal as to either the ratings or effective dates assigned therein. 38 U.S.C.A. § 7105(a)-(c); 38 C.F.R. §§ 20.200, 20.201 (1999). Therefore, the determinations in the April 1994 rating decision are considered finally adjudicated claims for the purpose of this appeal. Id; 38 C.F.R. § 3.160(d). The next communication referable to a claim for increased benefits was a statement received on June 26, 1995. In this statement, the appellant asserted that symptoms associated with his service-connected PTSD increased in severity, and that his service-connected condition rendered him unemployable. The RO construed the June 1995 statement as a new claim for increased compensation, to include the PTSD disability rating and the total rating based upon individual unemployability. The claims were denied by a rating decision dated in June 1996, on the basis that the evidence of record did not warrant an increased rating in excess of 50 percent for PTSD or a total rating based on individual unemployability. The appellant perfected a timely administrative appeal of these rating determinations. In a subsequent rating decision, dated in March 1997, the RO granted an increased evaluation to 70 percent for the PTSD, and also granted a total rating based on individual unemployability based upon the service-connected disability. An effective date assigned for each of these awards, following the termination of a temporary total disability rating, was September 1, 1995. A timely administrative appeal as to this effective date was likewise perfected. During the course of the administrative proceedings before the RO, VA outpatient records dated between December 14, 1992 and May 26, 1993, were received in October 1997. These records reflect that the appellant received regular, approximately monthly treatment and medication for his PTSD. These records collectively show that the appellant complained of continued depression and anxiety; that he had occasional suicidal thoughts with no intent on a plan; and that he reported situational stress related to family and marital problems. In February and March 1993, the appellant was reported to be psychiatrically "stable," with some improvement in his mood. In April 1993, he was found to being doing better, although he continued to be depressed. Following a mental status examination in May 1993, it was noted that the appellant and his son had been living together for the previous three months. The examiner indicated that the relationship between the appellant and his son involved neither open conflict nor conflict avoidance. According to the examiner, the relationship appeared to involved some confusion over boundaries as well as regulating closeness. The appellant was reported to have chronic suicidal ideation, but no strong thought was indicated during examination. The resulting diagnoses included PTSD with depression. VA records pertaining to outpatient treatment and transition therapy, for the period from July to December 1993, reflect that during these sessions the veteran complained of PTSD symptoms which included anxiety, depression, sleeping problems, and feelings of hopelessness, dysphoria, and isolation. These records disclose that during evaluations conducted between July and September 1993, the appellant's affect was flat; and his mood was depressed. His insight was fair; and his judgment was logical and coherent. No suicidal ideation was present. According to the examiner, the appellant had made an appropriate adjustment to his hospital discharge; he was stable on medication; and there was no evidence of psychosis. Although it was noted that the appellant had experienced some reaction to his combat anniversary in late September 1993, he coped appropriately with that reaction and was goal directed in working on his property. During the following sessions conducted in October and November 1993, the appellant's psychiatric disability was consistently found to be stable. In December 1993, it was noted that the appellant's mood was dysphoric, with no evidence of suicidal ideation, and it was indicated that he was goal directed. The diagnosis was of PTSD. VA outpatient records dated between January 1994 and August 1995 show that the appellant received outpatient therapy and treatment for his service-connected PTSD. In January 1994, when he was seen by VA, it was noted that the appellant was able to cope and handle his anxiety, that he felt better during the holiday season, and that his relationship with his son was going well. It was also noted that the appellant stayed in contact with his friends, that he took walks, and that he was maintaining a positive attitude, including being able to appropriately handle the circumstances of a minor automobile accident. During sessions in February and March 1994, the appellant's mood was appropriate; he was able to handle problems; and he worked on his property without being totally withdrawn. He continued to express the enjoyment of living with his son; and he was proud that he did not need be hospitalized. It was noted that he was taking his medication, which helped considerably; that he felt more in control; and that he was doing well. The appellant was observed as slightly more cheerful and interested in his PTSD program. In May 1994, it was noted that the appellant had a difficult period, which re-evoked many traumatic memories, but that he was doing well reasonably well on medication. When the appellant was seen on June 7, 1994, it was noted that he was having difficulty in dealing with Memorial Day. The appellant also indicated that he was having relationship problems with his sister. Subsequent session entries in June 1994 (on the 14th, 21st, and 28th), indicated that the appellant was observed as attentive; that he discussed the events of a recent visit with his sister; and that he was having difficult times associated with his "anniversary." In July 1994, the appellant related increased symptoms of depression due to recent anniversary experiences, and he complained of ongoing insomnia. In August 1994, it was noted that the appellant continued to feel depressed and was living from "day to day," His depression was described as flaring. It was reported that he was not sleeping well and was still sitting around the house. In October 1994, the appellant presented with symptoms of a depressed mood, intrusive memories and thoughts to harm himself, occasional flashbacks, and social withdrawal. He related additional symptoms which included increased sadness, chronic crying spells, and continued nightmares. Mental status evaluation conducted during this session revealed that the appellant's speech was directed. His mood was noted as "always depressed." His affect was restrained but with appropriate reactions. He admitted suicidal ideation. No thought disorder was indicated. The diagnoses include PTSD. When he was seen in December 1994, the appellant related no change in his symptoms. Additional outpatient entries dated in February 1995 indicated that the appellant reported a decrease in the occurrences of nightmares. He was continued on his course of medication and therapeutic treatment. In March 1995, he related continued symptoms of nightmares. When he was seen in April 1995, the appellant described increased social isolation, secondary to a recent marked increase in symptoms similar to social phobia, palpitations, shortness of breath, derealization, an urge to flee, a decreased sense of ability to understand what he hears, and dizziness when approaching people. The examiner noted that, in the past, the appellant was having good results with prescription medication, but that the appellant has presented with many of the symptoms described during this visit. Mental status evaluation conducted during this visit revealed that the appellant was neat and clean, but restless. He was oriented to time, place, and person. He was observed as hypervigilant and occasionally distracted by noises outside of the room, but his thoughts were otherwise directed. His mood was noted as "real nervous." His affect was noted as pleasant, but obvious anxiety was detected. No homicidal or suicidal ideation was indicated. The diagnosis was of PTSD. Other outpatient entries dated in May 1995 reflect that the appellant presented with a chief complaint of an attempted suicide with an overdose of a prescription drug. Complaints of increased depression and PTSD symptoms, due to the appellant's anniversary date and the Oklahoma City bombing, were also reported. It was noted that the appellant could not tolerate crowds or large cities; that the suicide attempt was in response loneliness. It was further noted that the appellant lives in isolation except for his son, who was away from the home on the previous day. The appellant was referred for VA hospitalization. The diagnoses were of PTSD with depression, and suicide attempt. A VA hospital report pertaining to inpatient treatment from May to June 1995, disclosed that the appellant was admitted following an overdose of psychiatric medication. The appellant reported an exacerbation of his PTSD symptoms around this time of the year. It was noted that the appellant was also upset concerning the recent bombing of a federal building, which caused him to experience panic attacks with anxiety, palpitations, and a feeling of impending doom. He also reported symptoms of nightmares, flashbacks, and intrusive thoughts related to his Vietnam experiences. On mental status examination, there was no evidence of overt thought disorder. His affect was depressed. The report noted that the appellant exhibited some improvement with this treatment course of medication. Upon discharge, the appellant was continued on medication and was referred for follow-up evaluation on an outpatient basis. The final diagnosis was of PTSD, and the GAF score was 45. In a June 1995 medical statement, the clinician noted that the appellant had experienced an increase in the severity of his PTSD symptoms, to include nightmares, flashbacks, intrusive thoughts, social avoidance, sleep disturbance, difficulty concentrating, hypervigilence, heightened irritability, and estrangement from family and friends. It was also noted that the appellant experienced frequent panic attacks and major depression secondary to PTSD. It was the clinician's assessment that the appellant's social and occupational functioning, as well as his family functioning were profoundly impaired. The appellant was noted to remain isolated in his home, and to experience frequent suicidal thoughts. It was noted that the appellant experienced difficulty in completing minimal tasks, and could not be expected to meet even minimal employment duties. A GAF score range of 25 to 35 was noted. Finally, it was noted that the appellant's PTSD symptoms have persisted despite a variety of treatment interventions and medications, along with several periods of hospitalization. The clinical assessment was severe PTSD with profound impairment in social, occupational, and family functioning; and that the appellant was completely unemployable. The appellant was again admitted to a VA hospital from June to August 1995. This hospital report indicated that the appellant presented with complaints of depression with suicidal ideation, manifested by dysphoria and anxiety. During the course of this hospitalization, the appellant experienced extensive distressing flashbacks with nightmares, and an inability to sleep. On mental status evaluation, the appellant was evaluated with an unhappy mood. His affect was quite constricted, and nonreactive. His thought process was linear and goal oriented. His thought content showed no suicidal ideation while hospitalized. It was the examiner's assessment that the appellant would be actively suicidal if not hospitalized. There was no evidence of auditory or visual hallucinations. His judgment and insight were fair. A final diagnosis of severe major depression, PTSD, and ethanol dependence in remission (Axis I) was indicated. A GAF score of 45 was noted. VA clinical records dated from July to August 1995 collectively show that the appellant attended and participated in a PTSD support group. During these group sessions, the appellant discussed the chronic nature of his PTSD, the difficulties of identifying appropriate medication, and a recent confrontation he had with son concerning his PTSD treatment. An August 1995 VA examination report indicated that the appellant reported subjective complaints of severe flashbacks with scenes of combat in Vietnam, nightmares, poor appetite, and depression. The appellant reported some improvement in his symptoms of depression with his current treatment course. On evaluation, the appellant was noted to appear older than his stated age. He was noted to be well-dressed and neatly groomed. He was oriented and alert. There was no evidence of psychomotor agitation or retardation. His speech was normal and fluent. The appellant's affect was somewhat anxious and sad. His mood was mildly depressed. The appellant denied any homicidal or suicidal ideation. He also denied any delusions or hallucinations. His attention and concentration were evaluated as fairly good, and memory and cognition were grossly intact. His judgment and insight were fairly good. The diagnostic impression was PTSD (Axis I), and personality disorder, not otherwise specified (Axis II). A GAF score range of 50 to 55 was noted. The examiner noted that the appellant was an inpatient at the VA medical facility at the time of this examination, for stabilization of his PTSD symptoms. It was the examiner's assessment that that the appellant demonstrated severe symptoms at that time. The appellant was next hospitalized from December 1995 to January 1996 for suicidal ideation. The appellant reported symptoms of increased flashbacks, intrusive memories, increased depression, and suicidal ideation since October 1995. It was noted that the appellant did not identify any precipitants to his suicidal thoughts. The appellant reported decreased sleep, appetite, concentration, energy, and interests. The medical report indicated that the appellant initially experienced very poor sleep secondary to flashbacks, and nightmares. The appellant continued to express depressed mood and suicidal ideation for several days. Thereafter, the appellant's PTSD symptoms decreased, with no reported flashbacks or nightmares several days prior to discharge. The appellant was discharged on medication, and referred for continued outpatient treatment. The final diagnosis was major depression, recurrent; PTSD; and alcohol dependence (Axis I). He was also evaluated with a borderline personality disorder (Axis II). A GAF score of 60 was indicated. It was noted that a GAF score of 40 was evaluated at the time of the appellant's admission. Clinical records, dated from January 1996 to August 1996, document intermittent treatment the appellant received for continued PTSD symptoms. A January 1996 clinical report indicated that the appellant stated that he was doing poorly, and reported symptoms of isolation. The appellant underwent VA hospitalization in May 1996 following suicidal ideation. Upon admission, he reported the stress associated with the anniversary date of his PTSD diagnosis. He also reported the belief that his son did not love him, and that the two were nearly involved in a shoot out two to three weeks earlier. He reported chronic suicidal ideation, insomnia, lack of interest, concentration, energy, and appetite. He reported feelings of guilt. At the time of his admission, the appellant was alert. He was observed to be unkempt, and tremulous. His mood was depressed and angry. His affect was irritable. His thought content was most coherent, although the appellant was noted to become tangential and derailed. There was no evidence of loose associations, or flight of ideas. He denied auditory or visual hallucinations, homicidal ideation, or delusions. The appellant was noted to continue to complain of depression and pain throughout his hospitalization. At the time of his discharge, the appellant denied any suicidal plan or intent. The medical report indicated that the appellant was found to have received the maximum benefit from this hospitalization, and was discharged but continued on medication. He was referred for follow-up evaluation. When seen in June and August 1996, the appellant reported that he felt less distressed. In September 1996, the appellant filed an application for a total rating based upon individual unemployability. In his application for benefits, he indicated that he was rendered unemployable due to his PTSD. He indicated that he was last employed in 1990. The appellant reported that he received a high school education, and received specialized training in mechanics. It was also noted that the appellant had participated in vocational rehabilitation. On VA general medical examination, conducted in January 1997, the appellant was evaluated with multiple disorders, to include findings of a history of PTSD, and was noted to be a "recovering alcoholic." On VA PTSD examination, conducted in January 1997, the appellant reported subjective complaints of anxiety when outside of his home environment. He also reported symptoms of racing thoughts when under stress, bad dreams, intrusive thoughts when under stress, bad dreams, difficulty sleeping, flashbacks, and chronic irritability. The appellant reported that he previously attended group therapy, but was unable to continue due to difficulties with travel arrangements. During the interview, the appellant reported that he spends a typical day reading, talking to his pets, taking walks, and watching television news. He reported that he visits with townspeople when he retrieves his mail from the community mailbox. The appellant noted that he performs all of his own activities of daily living. He denied suicidal ideation. Mental status evaluation revealed no evidence of psychotic processes. The appellant demonstrated a full range of affect, including the possibility of some humor. His mood was mildly depressed. It was noted that the appellant utilized marijuana for management of chronic pain due to fibromyalgia. The diagnostic impression was PTSD, and chronic major depressive disorder (Axis II). A GAF score of 50 was indicated. During social and industrial evaluation in February 1997, the appellant reported that he served in Vietnam for one year. Relative to his service in Vietnam, the appellant reported that he sustained multiple injuries. The appellant reported exposure to herbicide agents. He also described events that occurred within the combat zone, to include when his unit was overrun by North Vietnamese soldiers. In this context, it was noted that the appellant reported that his unit was constantly moving under fire with no relief. The appellant reported that following his release from service, he moved to another state to reside near his sister, and began working for a trucking company. He stated that because of his inability to get along with fellow employees, he left this position after six months. He reported that he left his next position after six months due to similar reasons. The appellant thereafter experienced legal difficulties, and was detained for a period of time. Thereafter, the appellant secured employment and married in 1972. He subsequently separated from this wife, relocated to another state where he resided in the hills, and worked at odd jobs. He remarried in 1984, and opened a store. The appellant reported a history of suicide attempts since 1987. He indicated that he last worked in 1990. During social and industrial survey, the appellant reported that he maintained a good relationship with his older sister. He indicated that he maintained regular biweekly telephonic contact with his mother and stepfather. The appellant was noted to have been first psychiatrically hospitalized in 1987, following a suicide attempt. He was also treated for alcohol dependency. The appellant was noted to have participated in the inpatient treatment program from January to May 1991. Since that time, the appellant has had multiple hospitalizations, each precipitated by a suicidal ideation, depression, and PTSD symptoms of flashbacks and nightmares. The appellant described additional current symptoms of isolation, and intrusive thoughts. The appellant reported that he was on prescribed medications, and received individual counseling. He reported his primary symptoms as nightmares, flashbacks, and intrusive thoughts. Evaluation revealed no psychotic symptoms. The examiner opined that the appellant's chronic suicidal ideation and chronic emptiness might be indicative of a comorbility of borderline personality disorder. The appellant was evaluated with markedly poor social adjustment. The examiner indicated that the appellant lived an isolated, lonely lifestyle with little interaction with others. The appellant was noted to not have any community involvement. The appellant was further evaluated as easily stressed, and noted to become suicidal, and to seek hospitalization when he feels overwhelmed by his stress. It was noted that the appellant was not working, and had no motivation or inclination to do so. It was further noted that the appellant viewed himself as a disabled person who could not possibly work at that time or in the future. In his assessment, the social worker indicated that "due to the chronic nature of the appellant's PTSD symptoms and the stress he experiences, the appellant "could not work today or anytime in the future." In an August 1997 rating action, the RO determined that an effective date prior to September 1, 1995 was not warrant for the award of an increased evaluation for PTSD, or for the award of individual unemployability benefits. In that regard, it was noted that the appellant's June 1995 claim for an increased evaluation for PTSD had been the subject of a pending appeal in this case. During this period, the appellant received intermittent total temporary ratings based upon periods of hospitalization in 1995 and 1996. It was noted that it was not factually ascertainable, based upon the medical evidence of record, that an increased evaluation was warranted prior to September 1, 1995. Further, it was noted that the appellant did not meet the eligibility requirements for entitlement to a total rating based on individual unemployability prior to September 1, 1995. Finally, the RO determined that an evaluation in excess of 70 percent was not warranted for the service-connected PTSD. In October 1997, the RO confirmed and continued the assigned 70 percent evaluation for PTSD, and the effective dates assigned for the awards for an increased schedular rating and for a total rating based on individual unemployability. Analysis I. Legal Criteria By regulatory amendment effective November 7, 1996, changes were made to the Schedule for Rating Disabilities for mental disorders, as codified at 38 C.F.R. § 4.130 (1999). Where the law or regulations change after a claim has been filed or reopened, but before the administrative or judicial appeal process has been concluded, the version most favorable to the appellant will apply. Karnas v. Derwinski, 1 Vet. App. 308, 313 (1991). Under the old rating criteria, the evaluation for the appellant's service-connected PTSD is based on the degree of impairment of his social and industrial adaptability. 38 C.F.R. §§ 4.129, 4.130 (1996). A 50 percent evaluation is for application where the ability to establish or maintain effective or favorable relationships with people is considerably impaired; or by reason of psychoneurotic symptoms, the reliability, flexibility, and efficiency levels are so reduced as to result in considerable industrial impairment. A 70 percent evaluation is warranted where the ability to establish and maintain effective or favorable relationships with people is severely impaired; or the psychoneurotic symptoms are of such severity and persistence that there is severe impairment in the ability to obtain or retain employment. 38 C.F.R. § 4.132, Diagnostic Code 9411 (1996). A 100 percent evaluation is warranted where the attitudes of all contacts except the most intimate are so adversely affected so to result in virtual isolation in the community; there must be totally incapacitating psychoneurotic symptoms bordering on gross repudiation of reality with disturbed thought or behavioral processes associated with almost all daily activities such as fantasy, confusion, panic, and explosions of aggressive energy resulting in profound retreat from mature behavior; or the veteran must be demonstrably unable to obtain or retain employment. Id. Under the revised criteria, the general rating formula for mental disorders is as follow: A 50 percent rating is warranted where the disorder is manifested by 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; and difficulty in establishing and maintaining effective work and social relationships. 38 C.F.R. § 4.130, Diagnostic Code 9411 (1999). A 70 percent rating is warranted where the disorder is manifested 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 that is 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 work-like setting); and an inability to establish and maintain effective relationships. Id. A 100 percent evaluation is warranted where the disorder is manifested by 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 oneself or others; an intermittent inability to perform the activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; and memory loss for names of close relatives, one's own occupation, or one's own name. Id. The governing regulations also provide that a total disability rating based on individual unemployability due to a service-connected disability may be assigned, where the schedular rating is less than total, when the disabled person is unable to secure or follow substantially gainful occupation as a result of service-connected disability. 38 C.F.R. §§ 3.340, 3.341, 4.16. If the schedular rating is less than 100 percent, the issue of unemployability must be determined without regard to the advancing age of the veteran. 38 C.F.R. §§ 3.341(a), 4.19. The regulations further provide that if there is only such disability, it must be rated at 60 percent or more; and if there are two or more disabilities, at least one disability must be rated at 40 percent or more, and sufficient additional disability must bring the combined rating to 70 percent or more. 38 C.F.R. § 4.16(a). In any event, it is the policy of the VA, however, that all veterans who are unable to secure and follow a substantially gainful occupation by reason of service connected disability shall be rated totally disabled. 38 C.F.R. § 4.16(b). Thus, if a veteran fails to meet the applicable percentage standards enunciated in 38 C.F.R. § 4.16(a), an extra- schedular rating is for consideration where the veteran is unemployable due the to service-connected disability. 38 C.F.R. § 4.16(b); see also Fanning v. Brown, 4 Vet. App. 225 (1993). Therefore, the Board must evaluate whether there are circumstances in the appellant's case, a part from any non-service-connected condition and advancing age, which would justify a total rating based on individual unemployability due solely to the service-connected conditions. See Van Hoose v. Brown, 4 Vet. App. 361, 363 (1993); see also Blackburn v. Brown, 5 Vet. App. 375 (1993). The Board notes that 38 C.F.R. § 4.16(c) was deleted from the rating schedule, also effective November 7, 1996, with the amendments for mental disorders. Section 38 C.F.R. § 4.16(c) is for application in the appellant's case, since his claim for an increased rating was filed before the regulatory change occurred. Under 38 C.F.R. § 4.16(c), the assignment of a 100 percent schedular rating is warranted in cases in which a veteran is rated 70 percent disabled due to a psychiatric disorder, the psychiatric disorder is the veteran's only compensable disability, and the psychiatric disorder is found to preclude him from securing or following a substantially gainful occupation. See Johnson v. Brown, 7 Vet. App. 95, 97 (1994) (discussing the applicability of 38 C.F.R. § 4.16(c)); see also Swan v. Derwinski, 1 Vet. App. 20 (1990). For a veteran to prevail on a claim based on individual unemployability, it is necessary that the record reflects some factor which takes the claimant's case outside the norm of other such veterans. See 38 C.F.R. §§ 4.1, 4.15. The sole fact that a veteran is unemployed or has difficulty obtaining employment is not enough. A high rating is, in itself, a recognition that the impairment makes it difficult to obtain and keep employment. Therefore, the question is whether the veteran is capable of performing the physical and mental acts required by employment, not whether he or she can find employment. See Van Hoose v. Brown, supra. II. Earlier Effective Date The method of determining the effective date of an increased evaluation is set forth in 38 U.S.C.A. § 5110(a) and (b)(2), and 38 C.F.R. § 3.400(o). The general rule with respect to the effective date of an award of increased compensation is that the effective date of such award "shall not be earlier than the date of receipt of application therefor." 38 U.S.C.A. § 5110(a) (West 1991). This statutory provision is implemented by regulation which provides that the effective date for an award of increased compensation will be the date of receipt of claim or the date entitlement arose, which ever is later. 38 C.F.R. § 3.400(o)(1) (1999). An exception to that rule applies, however, under circumstances where evidence demonstrates that a factually ascertainable increase in disability occurred within the one-year period preceding the date of receipt of a claim for increased compensation. In that regard, the law provides that the effective date of the award "shall be the earliest date as of which it is ascertainable that an increase in disability had occurred, if application is received within one year from such date." 38 U.S.C.A. § 5110(b)(2) (West 1991). See 38 C.F.R. § 3.400(o)(2). The term "increase" as used in 38 U.S.C.A. § 5110 and 38 C.F.R. § 3.400 means an increase to the next disability level. See Hazan v. Gober, 10 Vet. App. 511 (1997). The date of receipt of a claim is the date on which a claim, information, or evidence is received by the VA. 38 C.F.R. § 3.1(r) (1999). New and material evidence received prior to expiration of the appeal period or before an appellate decision is issued will be considered as having been filed in connection with the claim which was pending at the beginning of the appeal period. 38 C.F.R. § 3.156(b); see also VAOPGCPREC 12-98 (September 23, 1998). A claim is a formal or informal communication in writing requesting a determination of entitlement or evidencing a belief in entitlement, to a benefit. 38 C.F.R. §§ 3.1(p); 3.155 (1999). The regulation which governs informal claims, 38 C.F.R. § 3.155 (1999), provides as follows: (a) Any communication or action, indicating an intent to apply for one or more benefits under the laws administered by [VA], from a claimant . . . may be considered an informal claim. Such informal claim must identify the benefit sought. Id. Further, under 38 C.F.R. § 3.157(b)(1), an informal claim may consist of a VA report of examination or hospitalization. Under this regulatory provision, the date of the VA outpatient examination or hospital admission will be accepted as the date of receipt of a claim if such a report relates to examination or treatment of a disability for which service connection has previously been established. Id. In order to apply the above statutory and regulatory provisions to the instant appeal, it is necessary to determine the date of receipt of the appellant's claim for increased compensation, to include the PTSD disability rating and a total rating based on individual unemployability; and to determined the date that it became factually ascertainable that the appellant's service-connected PTSD increased in severity, to include his unemployability. Considering the former, the Board observes that the date of receipt of the appellant's claim for increased compensation was on June 26, 1995. That is the date that the VA received the appellant's statement in writing that he wanted an increased evaluation for PTSD, which included a component claim of entitlement to a total rating based on individual unemployability. The other indication in the record that the appellant applied for increased compensation benefits prior to June 1995, is the showing of his December 14, 1992 outpatient examination (and treatment) at VA. This additional evidence, which was received during the pendency of the June 1995 claim, is sufficient to constitute an informal claim for increased compensation. 38 C.F.R. § 3.157(b)(1); see also 38 C.F.R. §§ 3.156(b), 3.160(c). As such, the date of this VA outpatient examination "will be accepted as the date of receipt of [the] claim." 38 C.F.R. § 3.157(b)(1). Hence, the Board determines that date of receipt of the appellant's new claim for increased compensation, to include the PTSD disability rating and a total rating based on individual unemployability, is December 14, 1992. Id; see also Suttmann v. Brown, 5 Vet. App. 127, 136 (1993) (defining a new claim for increase). All other VA hospital and examination reports received during the pendency of the current appeal are dated after December 14, 1992, and therefore such VA reports would be useless if considered to be informal claims. 38 C.F.R. § 3.155. In considering the later, the Board must emphasize that the issue of increased compensation for the service-connected PTSD was the subject of final rating decisions by the RO in March 1993 and April 1994. In this regard, the RO determined that the evidence on file at that time did not support an increased rating for the service-connected psychiatric disability, which included a denial of a total rating based on individual unemployability. As aptly noted by the record, the appellant did not initiate an appeal, with respect to either of the rating decisions, following written notification in March 1993, and in May 1994, respectively. 38 U.S.C.A. §§ 5104, 7105(a)-(c) (West 1991); 38 C.F.R. §§ 3.104(a), 3.160(d), 20.200, 20.201 (1999). Thus, the effective date for a later increase in the 50 percent rating must be determined in relation to a new claim for increased compensation. See Suttmann v. Brown, supra (holding that a claim for increase "based on facts different from the prior final claim" is a new claim). In other words, since the RO's unappealed final rating decisions in March 1993 and April 1994 are "determinative, as a matter of law, that the evidence then before it did not show entitlement to [increased compensation benefits], the appellant is collaterally estopped from relitigating the same issue[s] based upon the same evidence, albeit for a different purpose." Hazen v. Brown, 10 Vet. App. at 520. Therefore, any later award of increased compensation, as to the PTSD disability rating and a total rating based on unemployability, must be based upon a new claim and, if the claim is granted (as occurred when the RO subsequently granted a 70 percent evaluation for PTSD and a total rating in the March 1997 rating decision), the effective date for the increase may not be based solely upon the evidence considered in the prior final decisions. Id. at 521. In this context, the Board determines that the "exception" to the general rule, as set forth in 38 U.S.C.A. § 5110(b)(2) and 38 C.F.R. § 3.400(o)(2), does not apply in that it was not "factually ascertainable" that the appellant's PTSD had increased in severity within the one-year period preceding the date of receipt of his new claim; that is one year prior to December 14, 1992. Here, the record reflects that the only evidence on file during the one-year preceding December 1992, were reports pertaining to inpatient and outpatient treatment provided by the VA during the period from January to November 1992, and a clinician's statement dated in September 1992. These medical data were considered as the basis for the denial of increased compensation, including the PTSD disability rating and a total rating based on unemployability, in the final unappealed rating decision of March 1993. To this extent, the Board is collaterally estopped from viewing that evidence any differently from the way it had been reviewed by the RO in March 1993. See Hazan v. Gober, supra. For this reason, these medical data cannot provide the sole basis for a rating in excess of 50 percent for PTSD, or for a total rating based on unemployability, within the one-year preceding December 14, 1992. Id. Similarly, the assignment of an earlier effective date during the one-year prior to December 1992, based upon the consideration of new evidence and evidence before the RO at the time of the final unappealed rating decisions in March 1993 and April 1994, is also not warranted. Id. at 520-522. In this instance, the Board notes that the appellant was admitted to a VA hospital in March 1992, for suicidal intention and depression. The evidence of record shows, however, that at hospital discharge in April 1992, the appellant's GAF score was recorded as 60 to 70, indicating that the symptomatology associated with his service-connected PTSD was productive of mild to moderate social and occupational impairment. See 38 C.F.R. §§ 4.125 (1991), 4.130 (1999) (incorporating by reference the VA's adoption of the American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Third & Fourth Editions (DSM-III & DSM-IV), for rating purposes). Although the record contains a September 1992 clinician's statement indicating that the appellant's PTSD symptoms resulted in severe social and industrial impairment, the Board observes that, in reviewing the medical evidence contemporaneous to that statement, there is an absence of medical data reflecting the severe degree of psychiatric disability noted by the clinician. In fact, the medical data of record show that the appellant was repeatedly assessed by VA treating physicians as a having a stable psychiatric condition. The appellant's PTSD symptoms were reported to be stable with medication in May 1992; and there was no evidence of suicidal ideation or psychosis found on mental status evaluation in June 1992. Moreover, upon VA hospital discharge in June 1992, the examiner opined that the appellant's PTSD symptoms had significantly improved, noting a GAF score of 70 to 80. Id (citing DSM-III & DSM-IV, which define a GAF score of 70 to 80 as revealing slight to mild social and industrial impairment). The medical data of record, dated between November 1992 and April 1993, also reflect that the appellant's mood was described as stable in November 1992; that the status of his psychiatric condition remained stable in February and March 1993; and that he was reported to be doing well in April 1993. Consistently, VA psychiatric examinations, dated between May 1993 and May 1994, have essentially found that the appellant has a depressed and dysphoric mood, a flat affect, logical and coherent judgment, and fair insight. These examination reports have also shown that the appellant has been goal directed; he has been coping with his anxiety; and he has established an enjoyable relationship with his son. These reports have also disclosed that the appellant was doing reasonably well, and that his PTSD was stable and controlled with medication. As such, the degree of psychiatric disability that would render the appellant severely disabled or unemployable is not clinically substantiated by the record, as illustrated by the evidence described above. Thus, it cannot be said that the PTSD symptoms manifested by the appellant were reflective of a rating higher than the then-assigned 50 percent evaluation, during the year preceding December 14, 1992. Therefore, the Board is unable to find that the criteria for a 70 percent schedular evaluation under Diagnostic 9411, or that the criteria for a total rating under 38 C.F.R. § 4.16, were met during the one- year period from December 14, 1991 to December 14, 1992. As a consequence, the general rule as set forth in 38 U.S.C.A. § 5110(a) and 3.400(o)(1) applies. See Harper v. Brown, 10 Vet. App. 125, 126-127 (1997). In this regard, the appellant contends that the clinical reports reflect that as early as 1994, his PTSD symptoms were of such severity as to render him totally disabled. This time frame, which corresponds to crises in his personal life, and which, presumably, include the contention that his PTSD symptoms worsened during these crises. Specifically, the appellant is contending that an effective date earlier than September 1, 1995 is warranted. The Board notes that in the March 1997 rating decision the RO found that the evidence demonstrated an increase in symptomatology sufficient to warrant a rating higher than 50 percent for the appellant's service-connected PTSD. Based upon clinical findings noted during VA hospitalization in May and June 1995, outpatient follow-up care, and findings documented during the most recent VA examination conducted in 1997, the RO determined that a chronic increase in impairment associated with the appellant's service-connected PTSD had been shown, and that this symptomatology was sufficient to warrant an increased rating of 70 percent, and to warrant a total rating based on unemployability. Thus, the effective date for the award of increased compensation for PTSD, including the 70 percent schedular rating and the total rating due to unemployability, was assigned based on the date of receipt of the claim for increase, then determined as June 26, 1995. Moreover, in this case, the appellant was in receipt of a total temporary rating under the provisions of 38 C.F.R. § 4.29, based upon his hospitalizations in May and June 1995. In pertinent part, this regulation provides for a temporary total (100 percent) rating where a veteran has required hospital treatment for a service-connected disability in a VA or an approved hospital for a period in excess of 21 days. 38 C.F.R. § 4.29. Therefore, the effective dates for the increased compensation awarded in conjunction with the March 1997 rating determinations, namely the increased evaluation of 70 percent and the award of a total rating based on individual unemployability, were assigned at the conclusion of the appellant's period of hospitalization, which was September 1, 1995. Since the appellant disagrees with the effective date assigned for the award of the 70 percent rating and the total rating due to unemployability, the Board's consideration of this appeal now turns on whether that level of disability was demonstrated by the evidence of record prior to September 1, 1995, but on or after December 14, 1992, the date of receipt of the new claim for increase. In applying the general rule, which governs the assignment of the effective date of an award of increased compensation, the Board determines that the assignment of the effective for the 70 percent schedular evaluation for the service-connected PTSD, and the award of the total rating due to individual unemployability, may be no earlier than June 7, 1994, the date of the increase. In this appealed case, it is not factually ascertainable that the symptomatology associated with the appellant's service-connected PTSD increased to the 70 percent level or rendered him unemployable prior to this date. Upon review of the evidence of record, the Board notes that while the medical data of record show that the appellant was hospitalized on at least three occasions in 1992 and 1993 due to PTSD symptomatology, these same medical data reflect that the appellant's psychiatric symptoms improved, with no sign of suicidal ideation, thought disorder, or psychosis; and that his psychiatric condition was assessed as stable with ongoing outpatient therapy and medication. As indicated above, VA treatment records, dating from January 1992 to May 1994, document that the appellant was able to establish a favorable relationship with his son, that he was able respond and handle problems appropriately, and that he was doing reasonably well on medication. Notably, however, the findings contained in a VA outpatient record, dated June 7, 1994, reveals that it was at this time that the appellant's psychiatric symptoms began to increase in severity without any demonstrable improvement. This outpatient session and those conducted thereafter show that the appellant began to exhibit increased PTSD symptoms associated with his anniversary, which included increased depression, intrusive memories, thoughts to harm himself, occasional flashbacks, and social withdrawal. He also complained of increased sadness and chronic crying spells. During the period from December 1994 to April 1995, the examiners reported no change in the appellant's psychiatric condition, and he was found to have a marked increase of symptoms, which included social isolation, social phobia, a decreased sense of an ability to understand, and attempted suicide, all of which resulted in the appellant being hospitalized for an extended period from May to August 1995. All of the other treatment and hospitalization records submitted for this claim, including medical opinions of record, are for dates corresponding to time after June 7, 1994. In further support of this notion, the record reflects that the appellant's clinician, in a letter written on the appellant's behalf in June 1995, documented similar PTSD symptomatology and expressed the opinion that such symptoms rendered the appellant unemployable. Therefore, the date of the increase must be considered to be June 7, 1994, as there is no other applicable records for which to derive a factually ascertainable increase in the appellant's disability. Under the applicable legal criteria, the effective date of the appellant's claim for increased compensation for the service-connected PTSD, to include the 70 percent schedular rating and the total rating based on unemployability, is governed by the later of the date of the increase or the date the new claim was received. 38 C.F.R. § 3.400(o)(1); see also 38 U.S.C.A. § 5110(a). In this appealed case, the later date is the date of the increase, June 7, 1994. Accordingly, the appeal is granted. III. Increased Evaluation in excess of 70 percent for PTSD Disability evaluations are determined by the application of the schedule of ratings which is based on average impairment of earning capacity. 38 U.S.C.A. § 1155. Separate diagnostic codes identify the various disabilities. It is essential, in evaluating a disability, that each disability be viewed in relation to its history. 38 C.F.R. § 4.1. Medical evaluation reports are to be interpreted in light of the whole recorded history, and each disability must be considered from the point of view of the veteran working or seeking work. 38 C.F.R. § 4.2. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Where there is an approximate balance of positive and negative 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. 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 evidence must preponderate against the claim. See also Alemany v. Brown, 9 Vet. App. 518, 519 (1996), citing Gilbert, 1 Vet. App. at 54. In this case, the appellant essentially contends that an increased evaluation is warranted for his PTSD. He maintains that symptoms associated with this condition reflect a greater disability picture than currently assessed. He further maintains that he is unable to maintain employment due to his service-connected disability and, as such, he is entitled to a 100 percent schedular rating for PTSD. Following a careful and considered review of the record, the Board finds that, with resolution of all reasonable doubt in favor of the appellant, symptomatology associated with the appellant's PTSD is productive of total occupational and social impairment pursuant to both the old and revised rating criteria of Diagnostic Code 9411. In that regard, the Board finds that the evidence shows that symptoms associated with the appellant's PTSD are consistent with findings that the appellant is demonstrably unable to obtain or retain employment, and that he is essentially isolated from the community, as reflected in the medical records dating from June 7, 1994. It was noted that the appellant essentially has no contact with people. In this context, the evidence establishes that the appellant does have sporadic minimal interaction with other townspeople whom he might encounter at the community mailbox. The appellant does maintain some form of telephonic contact with his mother and sister, but has a strained relationship with his son. Notably, on the most recent VA examination in 1997, the clinical findings revealed a full range of affect, with mildly depressed mood. The appellant was noted to have a significant history of suicidal ideation and attempts. The appellant was not evaluated with any impairment in thought processes, although it was opined that symptomatology revealed on examination might be indicative of a comorbility with a personality disorder. He was also noted to live in isolation, with little interaction with others. The appellant has a propensity to become easily stressed, and to experience suicidal thoughts when overwhelmed by stress. On VA examination, it was noted that the appellant displayed chronic PTSD symptoms, which impacted upon his social and industrial capacity to the extent that he was rendered him unable to work at present or at any time in the future. Further, the Board notes that the appellant has a notable history of treatment with prescribed medication and therapeutic counseling, apparently, without significant resolution of symptoms. It also appears that the appellant has been unable to obtain or retain employment. The examiner's assessment on VA examination was that the affect of the symptomatology associated with the appellant's psychiatric disorder rendered him unable to interact socially, and that the chronic severe nature of his symptomatology made him unable to maintain employment. A similar opinion was expressed by the appellant's clinician in a written statement dated in June 1996. While the appellant's PTSD disability picture does not meet each of the criteria of a 100 percent schedular evaluation, the Court has held that the criteria in Diagnostic Code 9411 for a 100 percent evaluation are each independent bases for granting a 100 percent evaluation (under the regulation for rating mental disorders effective prior to November 7, 1996). See, Richard v. Brown, 9 Vet. App. 266, 268 (1996); Johnson v. Brown, 7 Vet. App. 95, 97 (1994). As noted above, at least two of the three criteria for a 100 percent schedular evaluation are independently met in the appellant's case. Moreover, the Board also finds that it reasonable to conclude the symptomatology associated with the appellant's PTSD is productive of total occupational and social impairment, thereby warranting a 100 percent schedular evaluation under the new criteria of Diagnostic Code 9411 (effective on November 7, 1996). ORDER An effective date of June 7, 1994, for the assignment of a 70 percent evaluation for PTSD is granted, subject to the provisions governing the award of monetary benefits. An effective date of June 7, 1994, for the award of a total rating based upon individual unemployability due to service- connected disability is granted, subject to the provisions governing the award of monetary benefits. A 100 percent schedular evaluation for PTSD is granted, subject to the provisions governing the award of monetary benefits. Deborah W. Singleton Member, Board of Veterans' Appeals