UNITED STATES COURT OF APPEALS FOR VETERANS CLAIMS

No. 16-1208

JAMES GOLDEN, JR., APPELLANT,

V.

DAVID J. SHULKIN, M.D.,

SECRETARY OF VETERANS AFFAIRS, APPELLEE.

On Appeal from the Board of Veterans' Appeals

(Argued January 19, 2018 Decided February 23, 2018)

Ethan F. Maron, of Washington, District of Columbia, for the appellant.

Sarah W. Fusina, with whom Meghan Flanz, Interim General Counsel; Mary Ann Flynn,

Chief Counsel; and Selket N. Cottle, Deputy Chief Counsel, all of Washington, D.C., were on the 

brief for the appellee.

Before PIETSCH, GREENBERG, and ALLEN, Judges.

GREENBERG, Judge: The appellant, James Golden, Jr., appeals through counsel that part 

of a December 30, 2015, Board of Veterans' Appeals (Board) decision that denied a disability

rating in excess of 70% for post-traumatic stress disorder (PTSD).1 Record (R.) at 15-24. The 

issue before the Court is whether the Board may use Global Assessment of Functioning (GAF) 

scores when assigning a disability rating for psychiatric claims where the Diagnostic and 

Statistical Manual of Mental Disorders, Fifth Edition (2013) (DSM-5) applies. For the following 

reasons, the Court will vacate that part of the Board's December 30, 2015, decision on appeal and 

remand the matter for readjudication.

I.

The appellant is a Vietnam War veteran who served on active duty in the U.S. Army from 

July 1956 to March 1978, and is a recipient of the Vietnam Service Medal with four Bronze Service 

 

1 The Board also remanded the appellant's service-connection claims for (1) bilateral hearing loss; (2) erectile 

dysfunction and leakage; and (3) ischemic heart disease; the issue of a total disability rating based on individual 

unemployability was remanded with these claims. R. at 24-36. These matters are not before the Court. See Hampton 

v. Gober, 10 Vet.App. 481, 482 (1997).
2

Stars. R. at 77, 397, 875 (DD Form 214). During his decorated service in Vietnam, he endured 

rocket and mortar attacks, and was fired upon. R. at 858, 875.

In April 2010 the appellant filed for benefits based on service connection for PTSD. R. at 

927. The following month he sought treatment from a private psychiatrist for flashbacks, 

nightmares, weekly hallucinations, mood swings, suicidal feelings, and decreased memory. R. at 

874. The psychiatrist diagnosed the appellant with PTSD and assigned a GAF score of 40. Id.

In September 2010 a VA examiner noted the appellant's complaints of sleep impairment, 

nightmares, intrusive thoughts, flashbacks, hypervigilance, irritability, difficulties in crowds, 

anger, avoidance, depressed mood, concentration problems, and exaggerated startled response. R. 

at 858-60. The appellant also reported to the examiner he had retired from his job as a corrections 

officer because of psychological and physical conditions. R. at 858. The examiner diagnosed the 

appellant with PTSD and found moderate impairment in the appellant's social adaptability and 

ability to maintain employment, and diagnosed him with PTSD; a GAF score of 54 was assigned. 

R. at 859-60. In a July 2011 rating decision, the regional office (RO) granted service connection 

for PTSD, and awarded a 50% disability rating. R. at 594-605.

In April 2012 the appellant underwent another VA examination where he reported 

depression, anxiety, chronic sleep impairment, flattened affect and memory problems. R. at 532-

35. The examiner provided a GAF score of 50, finding that the appellant experienced disturbances 

in motivation and mood, difficulty in establishing or maintaining effective work or social 

relationships, a deteriorating marriage, and suicidal ideation. R. at 528-32. The appellant's PTSD 

disability rating was increased to 70% in November 2012. R. at 387-403. The appellant appealed

the rating assigned. R. at 301-02. The matter was certified to the Board on June 17, 2015. R. at 

65. 

In December 2015 the Board issued the decision on appeal, denying the appellant a 

disability rating in excess of 70% for PTSD. R. at 15-24. The Board acknowledged, as discussed

below, that the DSM-5 applied to claims certified to the Board after August 4, 2014, and that this 

edition of the manual had eliminated the use of GAF scores. R. at 17. The Board then discussed 

the appellant's various GAF scores, R. at 17, 19, 20, finding that 

GAF scores assigned during the relevant period do not provide a basis for assigning 

a higher rating. The Veteran's GAF scores have ranged from 40 to 54. Pursuant to 

the DSM-IV, a GAF score from 31 to 40 is indicative of some impairment in reality 

testing or communication (e.g., speech at times illogical, obscure, or irrelevant) or 
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major impairment in several areas, such as work, school, family relations, 

judgment, thinking or mood (e.g., suicidal ideation, neglects family, and is unable 

to work). A GAF score from 41 to 50 is indicative of serious symptoms (e.g., 

suicidal ideation, severe obsessional rituals, frequent shoplifting) or any serious 

impairment in social, occupational, or school functioning (e.g., no friends, unable 

to keep a job). Scores from 51 to 60 reflect moderate symptoms (e.g., flat affect and 

circumstantial speech, occasional panic attacks) or moderate difficulty in social, 

occupational, or school functioning (e.g., few friends, conflicts with peers or coworkers).

While the Veteran's GAF scores have fluctuated over time, his lowest score 

assigned – 40 in May 2010 – is consistent with no greater impairment than that 

contemplated by the assigned 70 percent rating. In fact, the Veteran has also 

received GAF scores that would indicate only serious or moderate 

symptomatology.

R. at 21-22. 

II.

The appellant argues that the Board failed to provide an adequate statement of reasons or 

bases when it failed to discuss favorable DSM-5 provisions. Appellant's Brief (Br.) at 4-10. At 

oral argument, the appellant clarified his position that he believed that GAF scores of record were 

still relevant evidence although the DSM-5 applied to the appellant's appeal. Oral Argument 

(O.A.) at 8:00-15:30, Golden v. Shulkin, U.S. Vet.App. 16-1208 (oral argument held Jan. 19, 

2018), http://www.uscourts.cavc.gov/oral_arguments_audio.php. However, he argued that these 

scores must be addressed in the context of the DSM-5's acknowledgement that the GAF scale was 

methodologically flawed and was particularly unreliable as applied to PTSD. Appellant's Br. at 7;

see also O.A. at 19:00-:30. 

The appellant also argues that the Board erred by failing to remand the matter of 

extraschedular consideration as inextricably intertwined with the remanded service-connection 

matters. Appellant's Br. at 8. The appellant further discussed extraschedular consideration at oral 

argument. See O.A. at 2:30-:30. 

The Secretary agrees with the appellant that the mere consideration of GAF scores in the 

Board's decision was not error and that, in fact, the Board is obligated to consider all pertinent 

evidence. Secretary's Br. at 6-7; see Appellant's Supplemental (Supp.) Br. at 2 (the Board has a 

"statutory obligation to consider all evidence of record" and therefore "must continue to consider 

GAF scores of record in claims certified to the Board after August 4, 2014"). However, the 
4

Secretary's argument diverges from the appellant's in that the Secretary contends that the Board 

properly considered the totality of the evidence and the appellant's medical history, and that the 

GAF scores were just "another factor" in determining that the appellant was not entitled to a 

disability rating in excess of 70% for PTSD. Secretary's Br. at 8. The Secretary also contends 

that, in any event, any usage of the GAF scores in the Board's December 2015 decision was not 

prejudicial because the Board relied on the actual symptomatology to deny a higher rating. O.A. 

at 42:00-45:00. At oral argument, the Secretary suggested that VA's adoption of the DSM-5 was 

relevant to its duty to assist and that medical examiners should not use GAF scores after August 

4, 2014, when providing medical opinions; however, VA adjudicators were still required to 

consider existing GAF scores when determining the severity of a claimant's psychological 

disability. O.A. at 41:00-42:00. 

The Secretary also argues that the record did not reasonably raise a collective-impact 

extraschedular issue, and thus the appellant's argument that this matter should have been remanded 

as inextricably intertwined with his other remanded claims is without merit. Secretary's Br. at 9-

10 (citing Johnson v. McDonald, 762 F.3d 1362 (Fed. Cir. 2014) and Yancy v. McDonald, 

27 Vet.App. 484, 495-96 (2016)).

III.

The "Global Assessment of Functioning" scale was a scale ranging from 0 to 100, that was 

created to reflect "psychological, social, and occupational functioning on a hypothetical continuum 

of mental health illness." See DSM-IV at 32. In other words, a GAF score was a numerical 

summary on a standardized scale reflecting the presence and severity of psychological symptoms 

and their effects. Id. The goal of ensuring uniformity through the use of GAF scores did not appear 

to have been achieved, as "[i]t was recommended that the GAF [score] be dropped from [the] 

DSM-5 for several reasons, including its conceptual lack of clarity (i.e. including symptoms, 

suicide risk, and disabilities in its descriptors) and questionable psychometrics in routine practice." 

DSM-5 at 16.

Effective August 4, 2014, VA amended the portion of its Schedule for Rating Disabilities 

dealing with mental disorders to remove outdated references to the DSM-IV and replace them with 

references to the DSM-5. See 79 Fed. Reg. 45,093, 45,094 (Aug. 4, 2014). VA adopted as final, 

without change, the interim final rule and clarified that the provisions of the final rule did not apply 
5

to claims that were pending before the Board, this Court, or the U.S. Court of Appeals for the 

Federal Circuit on August 4, 2014, even if such claims were subsequently remanded to the agency 

of original jurisdiction. See 80 Fed. Reg. 14,308 (Mar. 19, 2015).

IV.

The Court recognizes that, when the Board evaluates a disability, it is essential "that [the] 

disability be viewed in relation to its history," 38 C.F.R. § 4.1 (2017), and it is well established 

that the Board is obligated to consider all pertinent medical and lay evidence when rating a 

disability, Schafrath v. Derwinski, 1 Vet.App. 589, 593 (1991). To that end, the parties agree that 

GAF scores are at least minimally relevant as part of a veteran's psychiatric history. See Appellant's 

Br. at 7; Secretary's Br. at 6-7. However, both parties also agree that, although GAF scores were 

designed to help quantify and summarize the severity of symptoms associated with mental 

disorders, the DSM-5 eliminated GAF scores because of their "conceptual lack of clarity" and 

"questionable psychometrics in routine practice." DSM-5 at 16; see also Appellant's Br. at 6-7;

Secretary's Br. at 5-6. Given that the DSM-5 abandoned the GAF scale and that VA has formally 

adopted the DSM-5, the Court holds that the Board errs when it uses GAF scores to assign a 

psychiatric rating in cases where the DSM-5 applies. 

The Court disagrees with the Secretary's characterization at oral argument that the adoption 

of the DSM-5 pertained solely to VA examiners and the adequacy of VA examinations. See O.A. 

at 41:00-42:00. Although it is true that examiners no longer use these scores, an adjudicator is not 

permitted to rely on evidence that the American Psychiatric Association itself finds lacking in

clarity and usefulness. Any reliance on evidence that expert consensus—as adopted by VA—has 

determined to be unreliable would be impossible to justify with an adequate statement of reasons 

or bases. See 38 U.S.C. § 7104(d)(1) ("Each decision of the Board shall include . . . a written 

statement of the Board's findings and conclusions, and the reasons or bases for those findings and 

conclusions, on all material issues of fact and law presented in the record."); Gilbert v. Derwinski, 

1 Vet.App. 49, 56-57 (1990) (finding that Congress mandated, by statute, that the Board provide 

a written statement of reasons or bases for its conclusions that is adequate to enable the appellant 

to understand the precise basis for the Board's decision and to facilitate review in this Court); see 

also, e.g., Fagan v. Shinseki, 573 F.3d 1282, 1284 (Fed. Cir. 2009) (quoting a VA examiner's 

statement acknowledging that considering hearing loss using a disfavored whispered test "does not 
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provide frequency or ear specific information and therefore does not rule out, or confirm, high 

frequency hearing loss"). 

The Court also rejects the appellant's argument that the Board must consider GAF scores

to rate psychiatric disorders so long as the Board discusses how the unreliability of those scores 

affects the weight they should be assigned.2 Appellant's Supp. Br. at 2, 5. It makes little sense to 

impose a heightened reasons-or-bases requirement by obligating the Board to discuss how the 

American Psychiatric Association's rejection of GAF scores should affect the weight of such 

evidence. Instead, the Court provides far simpler guidance: the Board should not use such 

evidence at all when assigning a psychiatric rating in cases where the DSM-5 applies. 

The Board's rating analysis for psychiatric disorders has always been "symptom driven," 

meaning that "symptom[s] should be the fact finder's primary focus when deciding entitlement to 

a given disability rating." Vazquez-Claudio v. Shinseki, 713 F.3d 112, 116-17 (Fed. Cir. 2013); 

see also Bankhead v. Shulkin, 29 Vet.App. 10, 22 (2017) (requiring VA to "engage in a holistic 

analysis" of the claimant's symptoms to determine the proper disability rating); Mauerhan v. 

Principi, 16 Vet.App. 436, 440-41 (2002) (VA must consider "all the evidence of record that bears 

on occupational and social impairment," and then "assign a disability rating that most closely 

reflects the level of social and occupational impairment a veteran is suffering"). The Court simply 

clarifies that, to the extent that the Board may have been tempted to use numerical GAF scores as 

a shortcut for gauging psychiatric impairment, such use would be error. 

Further, the adequacy of medical examinations has never depended upon the use or 

inclusion of GAF scores. A medical examination is adequate "where it is based upon consideration 

of the veteran's prior medical history and examinations and also describes the disability, if any, in 

sufficient detail so that the Board's evaluation of the claimed disability will be a fully informed 

one." Stefl v. Nicholson, 21 Vet.App. 120, 123 (2007) (internal quotation marks omitted)). An 

examiner is tasked with thoroughly describing a claimant's current disability to allow an 

adjudicator to assign the appropriate rating, and must consider the current disability. See Monzingo 

v. Shinseki, 26 Vet.App. 97, 105 (2012) (per curiam) (holding that an adequate medical 

 

2 At oral argument, the appellant also suggested that GAF scores may be useful where the same examiner 

provided multiple examinations over time because the difference in GAF scores helped the adjudicator identify the 

examiner's opinion that a claimant's condition had changed. O.A. 12:04-12:50. However, an adequate examination 

must also be based "upon consideration of the veteran's prior medical history" and thus an examiner is already tasked 

with explaining any fluctuations in the severity of mental disability. See id. The Court therefore disagrees that GAF 

scores offer any added value for this purpose. 
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examination "sufficiently inform[s] the Board of a medical expert's judgment on a medical 

question and the essential rationale for the that opinion."). If the examiner does not provide this 

information with the requisite specificity, the examination is inadequate regardless of whether a 

GAF score is included. 

Although the Secretary argues that any mention of GAF scores in this case was not 

prejudicial error, the Court cannot deem the inclusion of these GAF scores harmless. See 38 U.S.C. 

§ 7261(b)(2) (requiring Court to "take due account of the rule of prejudicial error"). Although it 

is possible that the Board may have analyzed the appellant's GAF scores in response to his 

argument that his low GAF score of 40 entitled him to a higher rating, R. at 420-21 (Apr. 2013 

Substantive Appeal), the Board did not provide this explanation, and the Court is unable to 

conclude that the Board's decision would have been the same had the discussion of GAF scores 

been removed. The Court does not hold that the Board commits prejudicial error every time the 

Board references GAF scores in a decision, but in this case, it is unclear whether the Board's 

discussion of the GAF scores was prejudicial. Therefore, remand is required for the Board to 

provide an adequate statement of reasons or bases for its decision. 

As the Court is remanding the appellant's claim on a schedular basis, it is premature to 

address the appellant's arguments pertaining to extraschedular consideration. On remand, the 

appellant may present, and the Board must consider, any additional evidence and arguments. See 

Kay v. Principi, 16 Vet.App. 529, 534 (2002). This matter is to be provided expeditious treatment. 

See 38 U.S.C. § 7112; see also Hayburn's Case, 2 U.S. (2 Dall.) at 410, n. ("[M]any unfortunate 

and meritorious [veterans], whom Congress have justly thought proper objects of immediate relief, 

may suffer great distress, even by a short delay, and may be utterly ruined, by a long one.").

V.

For the foregoing reasons, the Board's December 30, 2015, decision is VACATED and the 

matter is REMANDED for readjudication consistent with this decision.