Citation Nr: 0006880 Decision Date: 03/14/00 Archive Date: 03/17/00 DOCKET NO. 93-19 510 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in San Juan, Puerto Rico THE ISSUES 1. Entitlement to an evaluation in excess of 50 percent for undifferentiated type schizophrenia. 2. Entitlement to a total rating based on individual unemployability due to service connected disabilities. REPRESENTATION Appellant represented by: American Red Cross ATTORNEY FOR THE BOARD J. L. Prichard, Counsel INTRODUCTION The veteran had active service from November 1978 to July 1985. This matter comes before the Board of Veterans' Appeals (Board) on appeal of rating decisions of the San Juan, Puerto Rico, regional office (RO) of the Department of Veterans Affairs (VA). It was previously before the Board in May 1995, but was remanded for further development. The requested development has been completed, and the case has been returned for further appellate review. FINDINGS OF FACT 1. The veteran's undifferentiated type schizophrenia is productive of no more than considerable social and industrial impairment. 2. The veteran's undifferentiated type schizophrenia is productive of no more than occupational and social impairment with reduced reliability and productivity due to such symptoms as flattened affect, circumstantial circumlocutory, or stereotyped speech, panic attacks more than once a week, difficulty in understanding complex commands, impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks), impaired judgment, impaired abstract thinking, disturbances of motivation and mood, and difficulty in establishing and maintaining effective work and social relationships. 3. The veteran's service connected disabilities include undifferentiated type schizophrenia, evaluated as 50 percent disabling, and labyrinthitis as a residual of a concussion, evaluated as 10 percent disabling; the veteran has a combined evaluation of 60 percent disabling. 4. The evidence does not indicate that the veteran's service connected disabilities are productive of an exceptional or unusual disability picture so as to render impractical the application of the regular schedular standards in determining the veteran's employability. CONCLUSIONS OF LAW 1. The criteria for an evaluation in excess of 50 percent for chronic undifferentiated schizophrenia have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 1991); 38 C.F.R. § 4.132, Code 9204 (1987); 38 C.F.R. § 4.132, Code 9204 (1996); 38 C.F.R. §§ 4.7, 4.130, Code 9204 (1999). 2. The criteria for a total rating based on individual unemployability due to service connected disabilities have not been met. 38 U.S.C.A. § 7104(c) (West 1991); 38 C.F.R. §§ 3.321, 3.340, 3.341, 4.16 (1999). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The veteran contends that the 50 percent evaluation assigned to his service connected undifferentiated type schizophrenia is insufficient to reflect its current level of severity. He argues that his disability leaves him unable to socialize or to function in a work setting, and that it requires frequent hospitalizations and treatment. He believes that his disability leaves him completely unemployable. Initially, the Board finds that the veteran's claims are "well-grounded" within the meaning of 38 U.S.C.A. § 5107(a); that is, plausible claims have been presented. Murphy v. Derwinski, 1 Vet. App. 78 (1990). An allegation of increased disability is sufficient to establish a well- grounded claim seeking an increased rating. Proscelle v. Derwinski, 2 Vet. App. 629 (1992). The Board is also satisfied that all relevant facts have been properly developed to their full extent and that the VA has met its duty to assist. White v. Derwinski, 1 Vet. App. 519 (1991); Godwin v. Derwinski, 1 Vet. App. 419 (1991). Increased Evaluation The evaluation of service-connected disabilities is based on the average impairment of earning capacity they produce, as determined by considering current symptomatology in the light of appropriate rating criteria. 38 U.S.C.A. § 1155. Consideration is given to the potential application of the various provisions of 38 C.F.R. Parts 3 and 4, whether or not they are raised by the veteran, as required by Schafrath v. Derwinski, 1 Vet. App. 589 (1991). In addition, the entire history of the veteran's disability is also considered. Consideration must be given to the ability of the veteran to function under the ordinary conditions of daily life. 38 C.F.R. § 4.10. If there is a question as to which of two evaluations should apply, the higher rating is assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is assigned. 38 C.F.R. § 4.7. The record shows that entitlement to service connection for a psychiatric disability was established in a September 1989 Board decision. This decision found that entitlement to service connection for a conversion disorder was merited. An October 1989 rating decision by the RO implemented the Board decision, and established an effective date for service connection from July 1985. A zero percent evaluation was assigned for this disability. A temporary total evaluation was assigned from February 1986 to April 1986, at which time a 10 percent evaluation was established. However, a temporary total evaluation was again assigned from April 1986 to June 1986, at which time a 50 percent rating was established. A March 1999 rating decision changed the diagnosis of the veteran's service connected disability to chronic undifferentiated type schizophrenia, and continued the 50 percent evaluation. This evaluation currently remains in effect, although temporary total evaluations for hospitalizations have been established on 10 other occasions since June 1986. The United States Court of Appeals for Veterans Claims, formerly the Court of Veterans Appeals (Court) has found that there is a distinction between a veteran's disagreement with the initial rating assigned following a grant of service connection, and the claim for an increased rating for a disability in which entitlement to service connection has previously been established. In instances in which the veteran disagrees with the initial rating, the entire evidentiary record from the time of the veteran's claim for service connection to the present is of importance in determining the proper evaluation of disability, and staged ratings are to be considered in order to reflect the changing level of severity of a disability during this period. In this case, the veteran submitted a notice of disagreement with the October 1989 rating decision in February 1990. Therefore, as this case involves disagreement with the initial rating decision, the Board will give consideration to staged ratings from the July 1985 effective date of service connection. Fenderson v. West, 12 Vet. App. 119 (1999). In the period since the veteran submitted his notice of disagreement, the VA has amended its regulations pertaining to the rating schedule for mental disorders, including schizophrenia, on two occasions. The first amendment became effective in February 1988. See 38 C.F.R. § 4.132, Code 9204 (1988). The second amendment became effective on November 7, 1996. See 38 C.F.R. § 4.130, Diagnostic Codes 9204 (1999). When a law or regulation changes after a claim has been filed or reopened but before the administrative or judicial appeal process has been concluded, the version more favorable to the veteran will apply. Karnas v. Derwinski, 1 Vet. App. 308, 313 (1991). The regulations governing the evaluation of undifferentiated schizophrenia were changed in February 1988 and November 1996. The RO has considered both the old and new regulations, most recently in a June 1998 supplemental statement of the case. Therefore, the Board is obligated to review the veteran's claim under the regulations in effect before and after February 3, 1988. Under the regulations in effect prior to February 3, 1988, active psychotic manifestations of such extent, severity, depth, persistence or bizarreness as to produce total social and industrial inadaptability was evaluated as 100 percent disabling. With lesser symptomatology such as to produce severe impairment of social and industrial adaptability, a 70 percent evaluation was warranted. Considerable impairment of social and industrial adaptability merited a 50 percent rating. Definite impairment of social and industrial adaptability was evaluated as 30 percent disabling. Slight impairment of social and industrial adaptability was evaluated as 10 percent disabling, and a zero percent rating was assigned when the psychosis was in full remission. 38 C.F.R. § 4.132, Code 9204 (1987). The only difference between this regulation and the regulation in effect subsequent to February 3, 1988, but prior to November 7, 1996, is that total social and industrial impairment was required for a 100 percent evaluation instead of complete social and industrial impairment, and mild impairment of social and industrial adaptability instead of slight impairment merited a 10 percent evaluation. 38 C.F.R. § 4.132, Code 9204 (1996). The Court has upheld an interpretation of this regulation which states that the criteria for a 100 percent rating are each independent bases for granting a 100 percent rating. Johnson v. Brown, 7 Vet. App. 95, 97 (1994). In Hood v. Brown, 4 Vet. App. 301 (1993), the United States Court of Veterans Appeals (Court) stated that the term "definite" in 38 C.F.R. § 4.132 was "qualitative" in character, whereas 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 purposes of meeting the statutory requirement that the Board articulate "reasons or bases" for its decision. 38 U.S.C.A. § 7104(d)(1). In a precedent opinion, dated November 9, 1993, the General Counsel of VA concluded that "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." VAOPGCPREC 9-93 (O.G.C. Prec. 9-93). The Board is bound by this interpretation of the term "definite." 38 U.S.C.A. § 7104(c). Under the regulations currently in effect, undifferentiated type schizophrenia is evaluated under the General Rating Formula for Mental Disorders. Under this formula, a 100 percent evaluation is warranted for total occupational and social impairment, due to such symptoms as gross impairment in thought process 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, or memory loss for names of close relatives, own occupation, or own name. A 70 percent evaluation is warranted for 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 a worklike setting), and an inability to establish and maintain effective relationships. A 50 percent evaluation is warranted for 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. A 30 percent evaluation is merited for 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 10 percent rating is warranted for occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or symptoms that are controlled by medication. For a zero percent evaluation, a mental condition must be formally diagnosed, but the symptoms are not severe enough either to interfere with occupational and social functioning or to require continuous medication. 38 C.F.R. § 4.130, Diagnostic Code 9204 (1999). The pertinent evidence includes the report of a VA examination conducted in September 1985. The veteran reported that he had been looking for a job since discharge from service. He had held some short term jobs. The reserves denied him entrance. On examination, the veteran was not spontaneous or talkative, but his responses were coherent and relevant. Some scattered pseudo-hallucinations had occurred. Ideas of reference were vaguely described, but no overt delusion was found. The veteran was well oriented, and his memory was grossly preserved. His capacity for reasoning was fair, but his judgment was poor. After review of an additional psychological report, the diagnosis was adjustment disorder, with some anxious mood. It was also indicated that some features of organicity should be further explored. The veteran was competent. The veteran was hospitalized at a VA facility from February 1986 to March 1986. His wife brought him because she could not handle him around the home. He reported hearing voices calling him, was unable to sleep, and walked around the house without any goals. On admission, the veteran was found to have scanty verbal communication, and to be uncooperative. He had an intense free floating anxiety, and was moderately depressed. At the time of discharge, the veteran was in contact with reality, and did not constitute a danger to himself or others. His disability was severe, and he could not hold gainful employment. The diagnosis was atypical psychosis. The veteran was again hospitalized at a VA hospital from April 1986 to May 1986. He was admitted due to auditory hallucinations and aggressive behavior towards his wife and children. On admission, the veteran was found to have tactile hallucinations, inappropriate affect, and a depressed mood. The assessment was that the veteran was severely disabled, and was unable to hold gainful employment or study. The diagnosis was atypical psychosis. The veteran underwent a private psychiatric examination in conjunction with a claim for Social Security Administration benefits in April 1986. He was noted to be on a pass from the hospital to come to the appointment. The diagnoses were post-traumatic stress disorder, and rule out organic brain syndrome. The examiner stated that the veteran appeared unable to handle his funds. The veteran underwent private psychological testing in July 1986. The conclusion was that the veteran was functioning intellectually below his true potential, due to serious emotional maladjustment. He seemed to suffer from paranoid and withdrawal tendencies, and although of mild intensity he suffered from an ongoing psychotic process. He was to be considered mentally disabled. The veteran was hospitalized at a VA facility from September 1986 to October 1986. He was hospitalized due to auditory hallucinations that commanded him to harm himself. There was an episode during hospitalization in which he became aggressive. At discharge, the veteran was alert and oriented, with clear speech. His thoughts were logical and coherent, with no homicidal or suicidal ideations. There were no active hallucinations, and the veteran was motivated for treatment. The diagnoses included atypical psychosis, and rule out post-traumatic stress disorder. The assessment of functioning was very poor. VA treatment records from December 1986 show that the veteran complained his medication was not making him well. He said that he heard voices almost all day. The assessment was that a change in medication was required. VA treatment records from January 1987 to September 1987 show that the veteran continued to receive regular treatment for his psychiatric disability. A February 1987 report of a VA psychiatric board notes that the veteran was currently hospitalized in the VA facility for psychiatric treatment. The board of two psychiatrist reviewed the claims folder and traced the veteran's history of psychiatric treatment from service to his present hospitalization. The previous diagnosis of atypical psychosis was noted, but it was felt that the diagnosis was not clearly defined. On examination, the veteran was very uncooperative. It was observed that he had a very voluntary component, and that his affect did not correspond to his complaints. The general picture suggested an inappropriate affect with a strong voluntary component very suggestive of a histrionic manifestation and expression. He was very evasive, uncooperative, and very difficult to explore appropriately. It was the impression of the board that the veteran had a marked voluntary component suggesting a factitious disorder versus a conversion disorder, but there was not enough evidence. A social service field survey was recommended followed by another psychiatric examination. April 1987 VA treatment records show that the veteran complained of hearing voices, and that this could happen at any time of the day. He was hostile, and the veteran exhibited persistent aggressiveness. The veteran said he had tried to take all his medications at once three days ago, but someone had stopped him. He admitted to destroying property at home. His affect was inappropriate, he was anxious and depressed, and he had no insight. The diagnoses included atypical psychosis. Following a social service field survey, and review of the claims folder, the VA psychiatric board re-examined the veteran in August 1987. The veteran was very superficial and vague about his symptoms. The board found inconsistencies in this case, and a lot of psychosomatic complaints. Without any evidence to confirm organicity, the board did not find any reason to explain a psychosis or even a depression. His memory was inconsistent, and his affect did not correspond to his complaints. The diagnosis was conversion disorder, hysterical neurosis. His highest level of adaptive functioning in the past year had been poor. He was competent to handle VA funds. VA hospital records dated from December 1987 to January 1988 indicate that the veteran was admitted due to loss of contact with reality, and complaining of auditory hallucinations, restlessness, anxiety, insomnia, and depression. The examiner stated that this was a severely disabled veteran that was unemployable. The diagnosis was chronic, undifferentiated schizophrenia, with acute exacerbation, and atypical depression. VA treatment records reflect that the veteran continued to receive ongoing treatment for his psychiatric disability from February 1988 to October 1989. July 1988 records note the veteran has chronic schizophrenia. They show that the veteran wanted his medication changed because he was hearing voices. He only slept for three or four hours, but this was more than before. September 1988 and November 1988 records reveal that he continued to have sleep problems and auditory hallucinations. The veteran underwent a private psychiatric examination in August 1988. His behavior during the interview appeared to be outside of reality, and a deterioration of his illness. The veteran reported that he had left work in December 1984, and that he had not returned because his condition had worsened. On examination, the veteran was not very cooperative, and not spontaneous. He appeared distracted with poor concentration and attention. His orientation in space, time, and person were affected. The veteran's insight was partially affected, but his judgment was preserved. The diagnosis was chronic undifferentiated schizophrenia, residual type. His ability to manage economic funds and personal interests was incompetent. VA treatment records from January 1989 note that the veteran continued to have somatic complaints, insomnia, and anxiety. In May 1989, the veteran reported that he had been feeling scared for the past three weeks. He was somewhat depressed, but there were no self destructive or aggressive ideas at present. The veteran was afforded a VA psychiatric examination in December 1989. The medical record, including the August 1987 report of the psychiatric board and reports of previous hospitalizations in which there had been diagnosis of chronic undifferentiated schizophrenia and atypical depression, was reviewed. The veteran was very vague in his complaints. He had a history of a very hysterical nature and many somatization tendencies. He also had a history of auditory hallucinations, but he was vague in describing the hallucinations and definitely not actively hallucinating during the course of the interview. The veteran would claim not to remember anything, but it would later come out that he did remember. His thoughts were organized and grossly logical. The thought content dealt mostly with somatization. He was not suicidal or overtly depressed. He was not delusional, although some referential ideas were present. The veteran was apparently very impulsive, and had poor control over his aggressiveness. He described his sleep as poor. The veteran had a certain degree of restriction in his affect. He was oriented, and in spite of his complaints, his memory was fairly well preserved. His judgment and insight were poor. The diagnosis was conversion disorder. His level of functioning was judged to be poor. He was felt to be competent. January 1990 VA records indicate that the veteran had increasing somatic complaints and auditory hallucinations. The assessment was that he was poorly stabilized. The veteran was hospitalized at a VA facility from January 1990 to February 1990. He was admitted after he was found in acute intoxication after a self harm attempt. The veteran was unemployed. He felt isolated, anxious, and depressed, with crying spells, which continued during the course of his hospitalization. He was treated with various forms of therapy, and medication. After the first week he became more sociable. At discharge, the veteran was in good mood, in full contact with reality, and clinically stable. The diagnoses were chronic, undifferentiated type schizophrenia, depression not otherwise specified, and suicide attempt. His level of functioning was poor. VA treatment records from January 1990 to April 1990 reveal the veteran continued to receive treatment. March 1990 records state that he was mildly depressed. The veteran was hospitalized at a VA facility from August 1990 to September 1990. He was admitted very depressed due to the death of his son the previous week and with ideas of self harm. He had a history of suicide attempts, and was admitted to prevent harm to himself or others. He experienced auditory hallucinations, and his medication was increased. The veteran was treated with the lowest effective dose of medication, and several forms of therapy. He was unemployable, and could not handle funds without a tutor. No further improvement was seen from this episode of care. The diagnosis at discharge was chronic undifferentiated type schizophrenia, with acute exacerbation. The veteran's level of functioning was very poor. The veteran was hospitalized from April 1991 to May 1991 in a VA facility due to complaints of depression, auditory hallucinations, and suicidal ideations. The diagnoses at discharge included chronic undifferentiated type schizophrenia, and depression not otherwise specified. His level of functioning was poor. VA treatment records dated March 1992 show that the veteran stated he felt bad, and that he believed he needed to be hospitalized, but that he was not ready. He looked very anxious, and said he had been hearing voices at home. He had insomnia, and was aggressive at home. The assessment was chronic undifferentiated type schizophrenia. The veteran was hospitalized at a VA facility from March 1992 to April 1992. He was admitted due to symptoms of depression, aggressive behavior at home, and persistent auditory and visual hallucinations. He was treated with medication. When the veteran felt less depressed and more in control of his aggressive impulses, he requested discharge. The diagnoses included acute exacerbation of chronic undifferentiated type schizophrenia. The veteran's score on the Global Assessment of Functioning (GAF) scale was 50 for the past year, and 55 at present. (GAF is a scale reflecting the "psychological, social, and occupational functioning on a hypothetical continuum of mental health-illness." Diagnostic and Statistical Manual of Mental Disorders (4th ed. 1994) [hereinafter DSM-IV]. A score of 51-60 indicates moderate symptoms, or moderate difficulty in social, occupational or school functioning. Ibid.). VA treatment records from June 1992 state that the veteran had recently been hospitalized due to insomnia, depression, agitation, and hallucinations. He was now stable, not suicidal or homicidal, and in contact with reality. The assessment was chronic undifferentiated type schizophrenia. The veteran was admitted to a VA facility from March 1993 to April 1993. He had been doing well until two days prior to admission, when he had a toothache that worsened his condition. He began hearing voices more constantly. The veteran said that he heard these voices all the time, and that they made jokes to each other and suicide plans. He also referred to flashbacks in which he saw an accident in the service. These symptoms made him anxious, irritable, and agitated, and he would break things around the house. The veteran was begun on medication, and gradually improved from his psychotic symptoms. He was discharged after receiving maximum hospital benefits. At discharge, the veteran was alert, oriented, and in full contact with reality, without any suicidal or homicidal ideation. The diagnoses included chronic undifferentiated type schizophrenia. His current score on the GAF scale was 50, and the highest in the past year had been 60. VA treatment records from June 1993 indicate that the veteran was not suicidal, homicidal, delusional, or hallucinating. In September 1993, the veteran said that he felt fine, and continued not to have delusions, hallucinations, and suicidal or homicidal ideations. December 1993 records show that the veteran was stable. The assessment was chronic undifferentiated type schizophrenia. The veteran was hospitalized at a VA facility in April 1994. He was admitted due to hearing voices, sadness, crying spells, and fear of losing control for the past week. At admission, he was alert, in full contact with reality, and not suicidal or homicidal. His mood was sad and his affect restrictive. During the hospitalization, he gradually improved from his depression and psychotic symptoms, and was able to participate in all ward activities. At discharge, he was in full contact with reality, and not suicidal or homicidal. The diagnoses included chronic schizophrenia, undifferentiated type. VA treatment records dated from 1994 are contained in the claims folder. In November 1994, the veteran said that he was feeling better, and that he was sleeping and eating fairly well. He was cooperative, in contact with reality, was not suicidal, and did not have hallucinations. The veteran was not overtly depressed. The veteran was hospitalized at a VA facility in April 1995. He came to the hospital feeling anxious, irritable, and afraid of losing control. He was sad and depressed, and had crying spells and auditory hallucinations. The veteran was treated with medication, and his symptoms gradually subsided. At discharge, the veteran was alert, oriented, coherent, and logical. He was not suicidal or homicidal, and did not have hallucinations. He was sleeping and eating well. The diagnoses at discharge included chronic undifferentiated type schizophrenia, and depression not otherwise specified. July 1995 treatment records show that the veteran continued to report that he was feeling better. He was still having some sleep problems. The veteran said that he had been less depressed since his hospitalization in April 1995. He was not suicidal, and did not have hallucinations. A social and industrial field survey was conducted in August 1995. This report noted that the veteran said he had attempted suicide by pouring gasoline on himself and lighting it, but that his wife had immediately extinguished the flames. When asked to show his scars, he pointed to his forearm, but there were none. He said that he did not seek medical treatment, but treated himself with creams and ointments. Two neighbors that were interviewed reported that the veteran would occasionally drive his car and went out frequently with his wife and children. He would take care of chores around the home, including mowing the lawn and "fixing things". It was added that no abnormal behavior was corroborated. The veteran underwent a VA psychiatric examination in June 1995. The report was prepared in August 1995 after the social and industrial survey was reviewed. The claims folder was available for review. The examiner noted that the veteran had 12 psychiatric hospitalizations between February 1986 and April 1995. He had been unemployed since military service. He was in receipt of Social Security benefits. The veteran reported that he had not been able to work since discharge from service. He complained of hearing voices, having suicidal ideas and attempts, and impulses that he could not control. He complained of isolation, irritability, and bad temper. On examination, the veteran was adequately dressed and groomed. He was alert and oriented. His mood was anxious and depressed, and his affect was blunted. The veteran's concentration was fair. He was not hallucinating, and he was not suicidal or homicidal. His insight and judgment were fair, and he exhibited good impulse control. The veteran was competent to handle VA funds. It was noted that an August 1995 Social Field Survey described some contradictions between the veteran's claims and the information provided by his neighbors. It was obvious that the veteran exaggerated his claims and symptoms. The diagnoses included chronic undifferentiated type schizophrenia with depressive features. The GAF was 60. The examiner added that the proper diagnosis was schizophrenia, and not conversion disorder. November 1995 VA treatment records state that the veteran was feeling better. He was less depressed, and did not have any hallucinations. He was in contact with reality. February 1996 records state that the veteran was free of acute psychotic symptoms. He still had difficulty falling asleep. There were no hallucinations, and he was moderately depressed. His memory was preserved. December 1996 records indicate that he still had no episodes of anxiety or sadness. He was in full contact with reality, but had fleeting auditory hallucinations. His memory was preserved, and his affect was depressed. The veteran was hospitalized at a VA facility from October 1997 to November 1997. He was admitted due to depressed feelings, crying, and self harm ideas. He also admitted to audio-visual hallucinations, and voices that told him to hurt himself. On examination, the veteran was alert, logical, coherent, and relevant. He was not spontaneous, but did answer when requested. The veteran was actively hallucinating on and off, including voices that said to kill himself. He had no delusional thinking. His memory was impaired for recent events, and his judgment and insight were poor. At discharge, the veteran was tranquil, with an euthymic mood, no perceptual disorders, and no evidence of suicidal or homicidal ideas. The assessment was chronic undifferentiated type schizophrenia, very deteriorated from a neuropsychiatric point of view. In the opinion of the examiner, the veteran was not able to handle funds, and not able to get involved in gainful activities. The GAF was 50. The veteran was afforded a VA psychiatric examination in July 1998. The claims folder was reviewed in conjunction with the examination. The previous June 1995 VA examination was also reviewed, and the examiner stated that the GAF of 60 assigned by that examiner represented a moderate degree of disability. The veteran had last been hospitalized in October 1997. He said that he had not worked since discharge from service. The veteran said that he was in better control on some days than others. He referred to hearing voices that told him to do things that were harmful to himself. The veteran described these things as bad ideas that he did not want to do, but that he was unable to control. He was in contact with reality, but restless. The veteran described auditory hallucinations, but was not actively hallucinating. He also referred aggressive ideas against others including his family, irritability, and on occasions cryfulness. His affect was somewhat inappropriate, and his mood was restless and somewhat depressed. He was oriented, with adequate memory. His intellectual functioning was average, his judgment was fair, and his insight was poor. The diagnoses included schizophrenic disorder, undifferentiated type, and some histrionic personality features. His GAF was 55 to 50. The veteran was mentally competent to handle funds. VA treatment records dated February 1999 records show that the veteran continued to have episodes of sadness and instability. He was in contact with reality, and was not suicidal or homicidal. No delusions or hallucinations were elicited. April 1999 records indicate that the veteran complained that he fatigued easily. He became angry without provocation. He kept himself socially isolated, and he said he had lost his zest for life. On examination, the veteran was distraught and unspontaneous. He was not suicidal or homicidal. The veteran reported fleeting auditory hallucinations, especially at night. He had a depressed affect and an anxious mood. His memory was partly impaired, and his judgment was poor. His GAF was 50. After careful review of the veteran's contentions and the evidence of record, the Board is unable to find that an evaluation in excess of 50 percent is warranted for any portion of the appeal period. The record shows that the veteran was hospitalized on 12 occasions between his service discharge and November 1997, and the records from these hospitalizations have been reviewed. He was awarded temporary total evaluations during periods of hospitalization. However, the overall evidence, including the VA examination reports, psychological testing, and the GAF scores does not demonstrate greater than the considerable social and industrial impairment contemplated by a 50 percent evaluation under the regulations in effect prior to 1996, or the symptomatology required for an evaluation in excess of 50 percent under the regulations currently in effect. The private psychological testing conducted in July 1986 stated that the veteran's psychotic process was of a mild intensity. The VA examination afforded the veteran in February 1987 was conducted by a board of two psychiatrists, who reviewed the veteran's claims folder and studied the history of the veteran's psychiatric disability from his date of discharge to the date of the examination. They believed that the veteran had a very strong voluntary component to his illness, and they noted that the veteran's affect did not correspond to his complaints about his illness. It was further noted that the veteran was evasive, uncooperative, and difficult to explore. Similarly, the August 1987 follow- up examination again found the veteran to be superficial and vague. The board was unable to find the evidence to explain a psychosis or a depression. The veteran was again found to be vague at the December 1989 VA examination. His history of a hysterical nature and somatization tendencies was noted. Although the veteran claimed a history of hallucinations, he was vague in his descriptions of them, and was not hallucinating at the time of the examination. He also indicated that he was unable to remember certain events, but it would later come out that he could remember them. Finally, at the August 1995 social and industrial survey, the veteran reported that he had tried to commit suicide by setting himself on fire, but when he tried to point out his scars, none were present. The VA examination report following the August 1995 social and industrial survey, indicated that it was obvious the veteran exaggerated his claims and symptoms. This report, as well as the opinions and evidence contained in the other reports suggest that many of the veteran's symptoms are exaggerated, and as the examiners who expressed these opinions had the benefit of reviewing the veteran's entire medical history, the Board finds that they are more probative than the hospital reports indicating more severe psychiatric symptomatology. The Board further finds that the GAF scores contained in the hospital reports, examination reports, and treatment records represents confirmation that many of the veteran's symptoms have been exaggerated, and that entitlement to an increased rating is not merited. The hospital records dated from March 1992 to April 1992 indicate that the veteran had a GAF score of 55 at discharge. He had a GAF of 50 at hospitalization discharge in April 1993, a GAF of 60 at VA examination in June 1995, a GAF of 50 in November 1997, a score of 50 to 55 in July 1998, and a GAF of 50 in February 1999. Overall, the scores are mostly in the 51-60 range. As noted by the DSM- IV, and by the July 1998 VA examiner, this represents no more than a moderate degree of disability due to symptoms such as a flat affect or circumstantial speech, occasional panic attacks, having few friends, or conflicts with peers or co- workers. This corresponds closely with the symptomatology required for a 50 percent evaluation under the regulations currently in effect, which also include a flattened affect, circumstantial speech, panic attacks more than once a week, and difficulty in establishing and maintaining effective work and social relationships. 38 C.F.R. § 4.130, Code 9204. While the veteran has displayed symptoms such as suicidal ideation, illogical speech, hallucinations, and disorientation, he was hospitalized on these occasions, and was granted a 100 percent evaluation until his symptoms improved. From a review of the overall record, it does not appear that severe symptomatology persisted. The more florid symptoms of psychosis have not been consistently displayed outside of the hospital. 38 C.F.R. § 4.130, Code 9204. And again, as noted above, the evidence suggests that the veteran exaggerates some of his symptoms. Therefore, when the overall disability picture is considered, the Board finds that the veteran's symptomatology is not productive of greater than the considerable social and industrial impairment contemplated by a 50 percent evaluation for any portion of the appeal period under the regulations in effect prior to 1996. 38 C.F.R. § 4.132, Code 9204 (1987); 38 C.F.R. § 4.132, Code 9204 (1996). Also, the veteran's symptomatology is productive of no more than the occupational and social impairment with reduced reliability and productivity that is contemplated by the 50 percent evaluation under the regulations currently in effect. 38 C.F.R. § 4.130, Code 9402. Therefore, entitlement to an evaluation in excess of 50 percent is not merited. Individual Unemployability The VA will grant a total rating for compensation purposes based on unemployability when the evidence shows that the veteran is precluded from obtaining or maintaining any gainful employment consistent with his education and occupational experience by reason of his service-connected disabilities. 38 C.F.R. §§ 3.340, 3.341, 4.16. If the appropriate rating under the pertinent diagnostic code of the rating schedule 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. Marginal employment shall not be considered substantially gainful employment. 38 C.F.R. § 4.16(a). According to the applicable laws and regulations, a total rating for compensation may be assigned where the schedular rating is less than total, when it is found that the disabled person is unable to secure or follow a substantially gainful occupation as a result of a single service-connected disability ratable at 60 percent or more or as a result of two or more disabilities, provided at least one disability is ratable at 40 percent or more, and there is sufficient additional service-connected disability to bring the combined rating to 70 percent or more. 38 C.F.R. Part 3, §§ 3.340, 4.16(a). However, a total rating based on individual unemployability may still be assigned to a veteran who fails to meet these percentage standards if he or she is unemployable by reason of his or her service-connected disability(ies). 38 C.F.R. § 4.16(b). Specifically, the regulations provide that, in exceptional cases where the schedular evaluations are found to be inadequate, an extraschedular evaluation commensurate with the average earning capacity impairment due exclusively to the service-connected disability or disabilities may be approved provided the case presents such an exceptional or unusual disability picture with such related factors as marked interference with employment or frequent periods of hospitalization as to render impractical the application of the regular schedular standards. 38 C.F.R. § 3.321(b)(1). In determining whether the veteran is entitled to a total disability rating based upon individual unemployability, neither his non-service-connected disabilities nor his advancing age may be considered. Van Hoose v. Brown, 4 Vet. App. 361 (1993); 38 C.F.R. § 3.341(a). In Hatlestad v. Derwinski, 1 Vet.App 164 (1991), the United States Court of Veterans Appeals (Court) referred to apparent conflicts in the regulations pertaining to individual unemployability benefits. Specifically, the Court indicated there was a need for discussing whether the standard delineated in the controlling regulations was an "objective" one based on average industrial impairment or a "subjective" one based upon the veteran's actual industrial impairment. The Board is bound in its decisions by the regulations, the Secretary's instructions and the precedent opinions of the chief legal officer of VA. 38 U.S.C.A. § 7104(c) (West 1991). In a pertinent precedent decision, the VA General Counsel concluded that the controlling VA regulations generally provide that veterans who, in light of their individual circumstances, but without regard to age, are unable to secure and follow a substantially gainful occupation as a result of service-connected disability shall be rated totally disabled, without regard to whether an average person would be rendered unemployable by the circumstances. Thus, the criteria include a subjective standard. It was also determined that "unemployability" is synonymous with inability to secure and follow a substantially gainful occupation. VA O.G.C. Prec. Op. No. 75-91 (Dec. 27, 1991). For a veteran to prevail on a claim based on individual unemployability, it is necessary that the record reflect some factor which takes the claimant's case outside the norm of such a veteran. See 38 C.F.R. §§ 4.1, 4.15 (1995). The sole fact that a veteran is unemployed or has difficulty obtaining employment is not enough. A high rating in itself is recognition that the impairment makes it difficult to obtain and keep employment. The question is whether the veteran is capable of performing the physical and mental acts required by employment, not whether the veteran can find employment. See 38 C.F.R. 4.16(a); Van Hoose, 4 Vet. App. at 363. If total industrial impairment has not been shown, the VA is not obligated to show that a veteran is incapable of performing specific jobs in considering a claim for a total rating based on individual unemployability. See Gary v. Brown, 7 Vet. App. 229 (1994). In addition to the veteran's service connected undifferentiated type schizophrenia, service connection is also in effect for labyrinthitis as a residual of a concussion. The evaluation for this disability is 10 percent. When this 10 percent evaluation is combined with the 50 percent evaluation for schizophrenia, a combined evaluation of 60 percent is reached. 38 C.F.R. § 4.25. This does not meet the necessary schedular rating for consideration of a total rating based on unemployability. Furthermore, the evidence does not show that the veteran's service connected disabilities are productive of an exceptional or unusual disability picture such as to render him unemployable. While the evidence indicates that the veteran has been hospitalized for his psychiatric disability on 12 occasions since discharge from active service, only one of these hospitalizations have been subsequent to April 1995. Although the veteran was said to be unemployable during hospitalization in January 1988, and unable to be involved in gainful activities during hospitalization in November 1997, the GAF scores of 50 to 60 that were assigned during this period, including at the November 1997 hospitalization, have not been consistent with a veteran who is unemployable. Moreover, the psychiatric evaluations that have had the benefit of a longitudinal review of the record, in addition to examining the veteran, have clearly shown that the degree of psychiatric impairment is less than that presented by the veteran during his many hospitalizations. It is clear that the RO has relied on the more comprehensive examinations in evaluating the psychiatric disability. The Board is unable to find that the decision of the RO not to refer the veteran's claim to the Director of the VA Compensation and Pension Service for consideration of a total rating on an extraschedular basis was an abuse of rating discretion. Therefore, entitlement to a total rating based on individual unemployability due to service connected disabilities is not warranted. ORDER Entitlement to an evaluation in excess of 50 percent for undifferentiated type schizophrenia is denied. Entitlement to a total rating based on individual unemployability due to service connected disabilities is denied. THOMAS J. DANNAHER Member, Board of Veterans' Appeals