UNITED STATE S COURT OF AP PEALS F OR VETERANS CL AIMS

N O . 01-468
A LBERT F. M AUE RHAN , A P P EL LA NT ,

V
. ANT HONY J. P RI N CI PI , S ECR ETA RY OF V ETER A N S A FF AI RS , A PP ELL EE
.

OnAp pe al f

rom the Bo ardof V ete ran s' Ap pe als
(Argued May 6, 2002 Decided October 30, 2002 )

Ro na ld L . Smi th , o f Wa sh ing ton , D .C ., for the ap pe lla nt. Richard A. Cohn , w ithwh om Ti m S. McClai n , G en era l C ou ns el; Jo an E . Mo ria rty , Acting A s s is ta n t G e n e ra l C o u n s el; Pat ric ia T ru jil lo , Acting Deputy Assist ant General Counsel ; and Eliz a b e th H. Go ldb erg , Appellate Att orney, were on the br ief, all of Washingt on, D.C., for the ap pe lle e. Before KRAMER, Chief Judge , and FARLEY and G REENE, Ju dg es . GREENE , Judge : V et er an Al be rtMauerhan appeals, t hrough counsel, a November 28, 2000, de cis iono f the B oard of Ve ter an s' A pp eal s (B oard) th at, re lyi ng o n 38 C .F .R . § 4. 13 0, Di ag no sti c Co de (D C) 94 11 , d en iedan inc rea sedini tia l ratin g f o r M r. M au erh an 's po st- traumatic str ess dis ord er (PTSD). Mr. Mauerhan f iled a bri ef and a repl y brief, and t he Secretar y filed a bri ef. A mot ion for expedited cons iderati on was granted due t o the veter an's fail ing health, a nd in May 2002 a panel of thi s C ou rt h ear d o ral arg ume nt. Onap pe al, Mr. Mau erh anarg ue s th at the Bo ard 's de cis ionwa s arb itr ary , c ap ric iou s, anab us e o f di scr eti on , or o the rw ise no t inacc ord an ce w iththe law , b ecaus e the Board fai led to d et erm ine a disabi lity ra ting based on PTSD symptom s establi shed in the Am eri canPs yc hiatri c A sso ciatio n' s Di ag no sti c a nd Stati sti ca l Ma nu al o

f Me nta l D iso rd

ers , a s
rev ise d inthe 19 94 , fo urth e dition(D SM -IV ). W e co nc lud e th at the Bo ard 's deci sio n w as n ot c learly erroneous and wil l affi rm the Board's decision.2 I. FACTS Mr. Mau erh anserv edon active duty in the U. S. Army f rom Se pte mbe r 19 67 to N ov emb er 1969, including se rvice in Vie tnam. Record ( R.) at 16. In June 1998, he f iled a cl ai m forVA service c onnection forhis PTSD. R . at 45-46. In an August 1998 letter in s upport of his claim, he de tai ledhis Army e xp eri en ces in V ietna m an d de scribe d ps yc ho log ica l dif fic ulties he hadsu ffe red since his r eturn fr om Vietnam. R. at52-54. In October 1998, he submitt ed a t reatme nt reportfrom the El kto n, Maryla nd , "V et C en ter ," i nd icating that he ha d begun medi cal tre atm en t inFe bru ary 19 98 in r esp on se t o th e fo llowing sympt oms : N igh tmares of V ietna m w ithint en se anx iety; g uil t;
su ici da l th ou gh ts; hy pe rvi ga lan ce; an d o cca sio na l in tru siv e th ou gh ts o f a f riendbe ing kil ledin Vietnam. R. at 58- 60. The exam iner noted t hat M r. Ma uerhan was anxious and tense and t hat he describe d h ims elf

as m oo dy an d ir

rit ab le. R. at 5 9. Th e ex ami ne r al so no tedthat Mr . M au erh an
ex hib ite d d eep re gre t an d s ev ere gu ilt for his Vi etn am s erv ice . R . a t 58 -60 . D uri ng the tre atm en t, Mr. Mauerha n reported ha ving been "arrest ed on one occasion for shoot ing at some one in his yar d." Id. The medical reports i ndicated t hat he had att empted sui cide thre e times , often fel t depresse d, and did not feel close to hi s famil y. Id. M r. Mauerhan was di agnosed with chroni c PTSD and dysthymia. Id . (D ys thy mia is " a d iso rde r of m oo d. " S TE DMAN ' S M EDI CAL D I CTI ONA RY 436 (5th u nabri dg edlaw ye rs e d. 19 82 )). In January 1999, Mr . Mauerhan was given a VA compensation and pens ion examina tion for PTSD. R. at 67-72. During that exam ination, he r eported tha t he had mar ried at a ge 18 and divorced 11 year s later

. Id. There were six c hildren f rom thatmarri age. Id

. H e st ate d th at h e h ad

remarr ied shor tly aft er the divor ce, but thatthat mar riage la sted only two year s. R. at 68. At the time of the exami nation, Mr. M auerhan repor ted that he has bee n in a 2 4- ye ar relati onship with a
woma n, wh om h e ca lls his wi fe. Id. He re po rte d ha vin g fla sh ba ck s an d int rus ive memories of Vi etn am a ndfel t as th ou ghh e ne ve r l eft V ietna m. R

. at 67

. H e statedth at he h ado ve rdo sedonpil ls a number of t imes and had a tt em pt ed t o ki ll h imself with a rif

le. Id. He tol d th e ex ami ne r th at before enl isting i n the Army he had neverkept guns in the house butthat he cur rently had f ive guns and slept with one loaded under hi s mattr ess. Id . M r. M au erh anrec all edto the ex ami ne r hi s d esi re to trade pl aces with his friend who was kil led afte r st ep pi ng o n a la ndmine in Viet nam, and the int en se s ho ck

he sti ll f eel s w he n rec all ing th e ex plo sio n of a Vi etn ame se bu s loa de d wi th c ivi lia ns . R. at 7 0. He rep ort edthat co nc ernfor his ow n s afe ty m ad e it

ex tre mel y d iff

icult to sle ep , o fte n3

prompting hi m to "walk ar ound the house and chec k the doors and windows over and over again." R. at 6 8. Al tho ug h h e re co un tednu mer ou s ar gu men ts a nd dif ficulties at w ork , M r. M au erh an rep ort edthat he hadmain tai ne d his curr en t job long er th anany othe r pos iti onhe hadheld , a ndwa s going into his ninth year a s an employee of the U.S. Postal Ser vice. R. at 71. Th e ex ami ne r ob serve d M r. M au erh an 's sp eec h to be cle ar an dc o h ere nt, "al tho ug h h e te nd ed to b e o ve rly tal ka tiv e an d a b it tan ge nti al at tim es . . . . " Id. Th e ex ami ne r fo un d M r. M au erh an in "good reali ty contact," oriente d, and providing no evidence of any delusions orhallucina tions. Id. Mr. Mauerha n's Global As se ssm ent of Functi oning (GAF) score of 52 was de termi ned to be "in dic ati ve of m od erate t o s eri ou s sy mpt omatology in vo lvi ng sh ort tempe r, i ns omn ia, hy pe rvi gil an ce, so cia l is olatio n, an d fr eq ue nt r eex pe rie nc ing ." R . a t 72 . T he ex ami ne r co nc lud ed that Mr. M auerhan's PTSD was secondary to his milit ary service and that his prognosi s was "fair ." Id. The examiner"s tr ongly recomm ended" thatMr. Mauerha n continue psychot herapy and reconsiderpsychotropic medicat ion for his sleep dif ficult ies and int rusive thought s. Id. In April of 1999, a VA regional offi ce (RO) awarded Mr. M auerhan ser vice connect ion for PTSD and assigned him a 30% disabili ty rati ng. R. at 76-81. Mr. Maue rha n filed a Noti ce of Disagreeme nt seeking an i ncreased rati ng for his service-connected PTSD, based on an April 1999 treatm ent reportfrom the Vet Center. R. a t 83, 96. The tr eatmentrepor t recorde d Mr. Mauerha n's pro gress in t he immed iat ely pre ced ing mon ths , b ut a lso no tedthat he rep ort edaninc rea se i n sy mpt oms . R

. at 84

. H e rep ort ede xp eri en cing "f req ue nt nig htm are s, p ain ful in trusive t ho ug hts , [an d] ov erw he lmi ng fe eli ng s of gu ilt a ndir rit ab ili ty. " Id . He als o in dic ate d th at h e w as " co ns ume d at time s b y a ng er a ndsad ne ss. " Id. Th e tre atm en t r ep ort li ste d his p rog no sis a s "gu ard ed ." Id. Mr. Mau erh an wa s g ive n a no the r V A ex ami natio n, whi chcon firmedthat he hadchro nic PT SD an d a s of M ay 19 99 ha d a

GA F s co re o f 50 . R . a t 86 -88 . T he RO is su eda d eci sio n c on tin uin g M r. Mauerhan's 30% disabili ty rati ng, and on August 16, 1999, Mr. Mauer han appealed t o the Board. R. at 98-101, 113. OnNo ve mbe r 28 , 2 00 0, the Bo ardde nie d e nti tle men t to aninc reased ini tial ratin g o f Mr

. Mau erh an 's PT SD , c on clu din g th at h is co nd iti ondoe s no t warra nt a ratin g gre ate r tha n 30 %. R. at 1-13. The Board recount ed the medi cal re ports fr om Mr. Mauer han's PTSD treat ments and examinat ions. R. at 3- 10

. T he Board t hen discussed 38 C.F.R. § 4.130, DC 9411, the regulat ion4

applied in r ating PTSD, and detaile d the criteria tha t would resultin 30% or 50% r atings. R. at 11. In applying t he rating c riter ia to Mr. M auerhan's condi tion, the Board s tated: Takin g in to a cco un t al l th e ev ide nc e, the Board finds that th e v ete ranis c urr en tly properly r ated as 30 per cent d isabl[e d]. Specifi cally, the evidence does not de mon str ate that the ve ter an 's PT SD is m an ife ste d b y o ccu patio na l an d s oc ial imp airmen t w ith reduc edrel iab ili ty andpro du cti vity d ue to s uc h s ymp tom s as flatt ened affec t, circum stantia l, circum locutory, or stereotype d speech, panic attacks more than once a week, diffic ulty in under standing com plex comma nds, impair ment of short- and lon g- te rm mem ory, impai red judgmentand abstrac t thinking, or dis tur ba nc es o f mo tiv ati on. Th ou ghthe ve ter ando es h av e so me d iff icu lty in est ab lis hin g a ndmai nta ini ng eff ective wo rk an d so cia l relatio ns hip s, that is , h e h as go tte n in to f

igh ts o n th e jo b, an d is soci all y is olated , it is n ote d th at h e h as b eenab le to m ain tai n a 24 [-] ye ar rel ati on sh ip wi th his p artne r, an d he d oe s stay in c on tac t w ith his ch ildren . F urthe r, h e h as b eenab le t o h olda jo b a t t he post off ice for the pa st nin e an d a half

ye ars . A s to dis tur

ba nc es o f mo od , th ou ghthe ve ter ando es s uff er from depr ession as well as thoughts of a foreshor tened futur e, as well a s of death and interm ittentsuic idal idea tion, the r eport of t he May 1999 VA PTSD examination found that he ge nerally f

unctions satisf

actoril y with routine behavior, sel f-care and no rma l co nv ers ati on , a ndhis g en era l c og nitive p roc ess es app ear edto b e in tac t. H is [G AF ] sc ore was foun d to be 52 in hi s Jan uary 19 99 exam inatio n, and50 in h is M ay 1999 examinat io n, which would indi cate only m oderate t o severe sym ptoms, or moderate diffic ulty to ser ious impai rment i n social, occ upati on al, or school fun cti on ing

. Th e rep ort

o f the J an uary 19 99 e xa min ati onfo un d the ve ter anto b e in good contact with r eality, and ori ented in al l t hree sphere s, with no evidence of any delusions orhallucina tions, and an i ntact me mory. R. at 11-12. I n conclusion, t he Board held thatthe "evide nce does not dem onstrate that the ve teran's PTSD warrants more t han a 30 percent disabili ty evaluation under the applicable sc hedular cr iteri a." R. at 12. On appeal, Mr. Mauerhan argues that the Board erred in relying on the 30% and 50% r ating cri teria lis tedu nd er 3 8 C .F .R . § 4. 13 0, as req uir em en ts rather t han exa mp les , b ecaus e th os e crite ria ap ply to a ll m en tal dis ord ers . In ste ad , h e cl aim s th at the Board, i n dete rmi nin g th e ap pro pri ate rating, shoul d have consider ed the cri teria specifi c to PTSD, set forth in t he DSM-IV. He contends that ma ny of the sy mpt oms lis tedin§ 4 .1 30 are no t fo un d inthe DS M-I V a s b ein g a sso ciatedwi th PTSD and, as a result, do notapply to PTSD claims . He claims t hat the Board's f ailure to use the DSM-IV is arbit rary and capr icious, an abus e of discr etion, and is notin accordance wit h the law. In r esp on se, the Se cre tary maint ain s that the Board di d no t err w he n it app lie d th e crite ria lis tedin the rating c od e to the e vid en ce co nta ine d inthe rec ordin o rde r to ass ignthe ap pro pri ate dis ab ili ty5

rating , a ndthat th e C ou rt s ho uldaff irm the Board' s dec isi onbecaus e it is su pp ort edby a p lau sib le basis in t he record.

II. AN AL YS IS Mr. Mauerha n seeks an incr eased init ial disa bility r atin g forhis servi ce-connect ed PTSD,

an d a lle ge s th at the Board er red i n d ecl ini ng to g ran t hi m a d isa bil ity rating gre ate r th an30 %. I n lig ht o f su cha ch all en ge , th e Co urt may set a sid e the Bo ard ’s f

ind ing as t o th e ap pro pri ate dis ab ili ty rating onl y if it is de termi ned to be clea rly err oneous. Se e 38 U. S. C. § 7 26 1(a )(4 ); Zink v. Brown , 10 Ve t.A pp . 2 58 , 2 59 (19 97 ) (p er c uri am o rde r); Gi lbe rt v . D erw ins ki , 1 Ve t.App . 4 9, 52 -53 (19 90 ). Under this st andard, the Courtmay not "subs titute its judgm ent for t hat of the B[oa rd] on issue s of mat eri al f act " an d may o nly ov erturna fi nd ing of the Bo ardif the re do es no t exi st a "p lau sib le b asi s" in th e re co rd t hat s upports the f actual det erminat ion at iss ue. Id. at 5 3; see als o 38 U.S.C. § 7 26 1(a )(4 ). Once a veteran ha s been awarded servi ce connecti on for a dise ase or disor der, VA will assign the veter an an appropri ate disabili ty r ating after referr ing t o the schedule of rati ngs for reduc tions in ea rning capacity for the s pecific inj ury or disabi lity. Se e 38 U.S.C . § 1155. The rating is based, as f ar a s p rac tic ab le, up onthe av era ge im pairments o f earni ng cap aci ty, in c ivi l oc cu pa tio ns , resulti ng f

ro m su ch injurie s. Id. The Secretar y has promulga ted regula tions to i mplement assig nm en t of

a n appropriat e disabil ity rat ing. Se e g en era lly 38 C.F.R. Pt. 4. In the process of evaluati ng a mental disorder, VA is required to cons ider a number of pe rtinentfactors , such as the frequency, se verity, and dur ation of a ve teran's psyc hiatri c symptoms

. Se e 38 C.F .R . § 4. 12 6 (2 00 1). After consi deration of

thes e fa ctors, and bas ed on all the evidence of r ecord thatbears on occupational and social i mpairm ent, VA must assign a disabil ity rat ing that m ost closel y reflec ts the level of s ocial and occ upational i mpairm ent a veter an is suff ering. See id. Where ther e is a question as to which of t wo evaluations t o apply, the Board wil l assign t he h ig he r rati ng if a vete ran's dis ab ili ty m ore clo sel y re sem ble s th e crite ria

for the hig he r ratin g; oth erw ise th e low er rating wi ll be assigned. Se e 38 C. F. R. § 4 .7 (20 01 ). U nd er the "G en era l R ati ng Fo rmu la f or M en tal Disorders," a rating of

30% for PTSD is appropr iate when a vet eran exhibi ts the fol lowing: Oc cu pa tio na l and social impa irm en t w ithoc cas ion al d ecr eas e inwo rk eff iciency and i ntermi ttent per iods of inabi lity to pe rform oc cupational tasks6

(although gene rally functioni ng sat isfact orily, with r outine behavi or, self- care, and conversati on n or mal ), due to such sym ptoms as: depressed m ood, anxiety, su sp ici ou sn ess , p an ic atta ck s (w eekly o r le ss o fte n), ch ron ic s lee p imp airmen t, m ild memory l oss (such as f

orgetti ng names, dir ections, r ecent event s)[.] 38 C. F. R. § 4 .1 30 , D C 9 41 1 a nd94 40 (20 01 ). Amen tal dis ord er i s to be rate d 5 0% d isa bli ng wh en the veter an exhibits the foll owing:

Oc cu patio na l an d s oc ial im pairmentwith reduced r eliabil ity and pro du cti vity due to such sympt oms as: f lattene d affect ; circum stantia l, circum locu to ry , or stereot yped speech; panic attacks more than once a week; difficulty in unde rstanding complex com mands; impair ment of short- and long-term memory (e.g., retent ion of on ly h igh ly l earne d material , fo rge tti ng to c omp let e ta sk s); imp air edjud gme nt; imp air edab str act

thi nking ; di stu rbanc es o f mo tiv ati onan d mo od ; di fficulty in establi shing and mai ntaining ef fective work and social r elations hips[.] Id

. Mr. Mau erh an arg ue s th at the Bo arderr edby tre ati ng the fac tor s sp eci fie d inDC 94 40 as req uir eme nts for

a p articular ra tin g, rathe r th anas e xa mpl es o f co nd iti on s th at w ou ld w arr an t a sp eci fic rating ass ign men t. H e co nte nd s th at m an y o f th e crite ria lis tedin the rating sched ule are
no t fou ndin the DSM -IV as be ing ass oc iat edwi th P TS D, an d th at the Bo ardsh ou ld h av e b ase d it s rating onthe sp eci fic eff ect s o f th e P TS D s ymp tom s se t fo rthin th e D SM -IV an d th e d eg ree to wh ichtho se sy mpt oms a ffe cte d his o ccu patio na l andso cia l orien tation . M r. M au erh anass ert s th at by restat ing verbati m the cri teria l isted in t he rating schedule under a 50% rati ng, and then denying a 50% rati ng becaus e he did notexhibi t t hose pr ecise symptoms, "the Board unla wfully denied t he [v]eter an an increa sed rati ng for his se rvice-c onnect ed PTSD because it found he di d not have symptoms unr elated t o PTSD." Appellant's Brief (Br.) at 8. Mr. Mau e rh a n ' s arg u me n t, th a t th e B o ardi mp ro p e rl y i n te rp re te d§ 4

. 1 3 0 , D C 9 4 4 0 , is a question of l aw, which the Court revi ews de novo. See Butts v. Brown , 5 Vet.App. 532, 539 (1993) (en banc) ( noting thatCourt reviews agency interpretat ions of law de novo). His asserti on that the sy mpt oms lis tedin the DSM -IV sho uld , in ef fec t, re pla ce th e cri teria lis tedin DC 944 0 a s th e b asi s for rating PT SD cla ims is n ot s up po rte d b y a plain r ead ing of the regulation. Se e G lov er v . We st , 185 F.3d 1328, 1332 (Fed. Cir. 1999), cer t. d en ied , 52 9 U. S. 1 10 8 (20 00 ) ( "Inc on struin g a st atu te
or re gulation, we com mence by inspe cting it s language to a scertai n its plai n meaning.") . Section 4. 13 0 s tat es: "T he no men clatur e emp loy edin th is p ortionof the rating sch ed ule is based upon the [D SM -IV ]. R ati ng ag en cie s mu st b e th oro ug hly fam ili ar w iththi s ma nu al t o . . . ap ply the ge ne ral7

rating f ormula f or mental disorders in § 4.130." 38 C.F.R. § 4.130 (emphasis adde d). Section 4.130 then list s diagnosti c codes for m ore than 30 me ntal di so rd er s and set s forth one "general rating formul a" t o b e u sedin r ating all the lis teddis ord ers . A lth ou gh§ 4 .1 30 mak es c lear th at a n
un de rst an din g o f th e D SM -IV is e sse nti al f or p rop erl y app lyi ng the rating formul a, n ow he re d oe s it s tat e th at c on sid eratio n of the D SM -IV ina ny w ay re lie ve s V A f rom ful ly c on sid eri ng the sp eci fic rating cri teria o utl ine d in38 C. F. R. § 4 .1 30 wh enrating the sev eri ty o f a c lai man t's dis ord er. Mr. Mau erh an co nte nds that the Bo ardco mmi tte d e rro r by sp eci fic all y re fer en cin g "s uc h symptoms a s flatt ened affec t, circum stantia l, circum locutory, orstereot yped speech, panic att acks more than once a week, dif ficult y in understandi ng compl ex com mands, impair ment of shor t- and long-ter m memor y, impair ed judgm en t and abstr act thinki ng, or disturbances of mot ivation." Appellan t's Br . a t 13 -14 , 1 8-1 9; see also R. at 1 1. He su gg est s th at b ecaus e ev ery on e o f th os e sy mpt oms is n ot r ele va nt t o P TS D, the Bo ardsh ou ld n ot h av e co ns ide red ea chon e inrating his disorder. Thi s argumentis not enti rely pers uasive. First, the symptoms r ecited underboth the 30% and 50% r atings in 38 C.F.R. § 4.130 follow the ph ras e "s uc h s ymp tom s as ." B y d efi nition , "s uc h a s" m ean s "f or e xa mpl e" o r "l ike or s imi lar to. " Se e W EBS TER ' S N E W W ORL D D I CTI ONA RY (3 rd c oll . e d. 19 88 ) 13 37 . T he us e o f th e te rm " su ch as" de mon str ate s th at the sy mpt oms aft er that phras e ar e no t i nte nd edto co ns titute an ex haus tiv e li st, bu t rathe r ar e to ser ve as e xa mpl es o f th e type and degree o f th e sy mpt oms , o r th eir eff ect s, that
wo uldjus tif

y a parti cu lar

rating . A cco rdi ng ly, an y s ug ge sti onthat th e B oard w as r eq uir ed , in

co mpl yin g w iththe reg ulatio n, to f indthe presence of al l, mo st, or e ve n s ome , o f th e en ume rat ed symptoms i s unsupported by a readi ng of the plain language of the regul ation. Se e G lov er , 185 F.3d at 1 33 2 (s tating that w he n te rms of r eg ulatio n are u na mbi gu ou s, "no furthe r inquiry i s u su all y required" ). Mr. Mauer han is correctthatthe f actors l isted in t he rating f ormula ar e "exampl es" of conditions t hat warrantparticul ar rati ngs. Without t hose example s, dif ferenti ating a 30% e valuation from a 50% evaluation would be extremely ambiguous. In § 4.130, r emoving the f actors f ollowing the ph ras e "s uc h sy mpt oms a s" wo uldle av e the B oard wi th the d iff icu lt t ask of d ete rmi nin g w he the r a veteran s uffered f

rom "[o] ccupational and social i mpairm ent wit h reduc ed relia bility a nd pro du cti vity" ( 50 % ratin g) o r "[ o]c cu patio na l an d s oc ial im pa irm en t w ithoc cas ion al d ecr eas e in
wor k eff iciency and i ntermi ttent per iods of inabi lity to pe rform oc cupational tasks (al though8

ge ne ral ly f

un cti on ing satisf

act ori ly, wi th r ou tin e b eh av ior , s elf -care, andco nv ers ati onno rma l)" (30% rat ing). Se e 38 C.F.R. § 4.130. Th e S ecr etary, acting wi thi n his auth ori ty t o "a do pt andap ply a sc he du le o f ratin gs ," c ho se to c reate one general ratin g formul a for ment al d iso rde rs. 38 U. S. C. § 1 15 5; see 38 U.S.C. § 501; 38 C. F. R. § 4 .1 30 . B y e sta bli sh ing one general formul a to be us edin r ati ng mor e th an30 men tal dis ord ers , the re canb e no d ou bt tha t th e S ecr etary anti cip ate d th at any li st of sympt oms justi fying a p articu lar

rating wo uldin m an y s itu ati on s be ei the r und er- or ove r-i nc lus ive . The Se cre tary' s u se of the phras e "such sympt oms as," f ollowed by a lis t of exampl es, provides gui danc e as t o the

sev eri ty o f sy mpt oms co nte mpl ate d fo r ea chrating , inad ditionto permittin g co ns ide rationof othe r symptoms, pa rticul ar to each ve te ra n an d disorder, a nd the effe ct of those symptoms on t he claima nt's social and work situat io n. This cons tructi on is not incons istent wit h Cohen v. Brown , 10 Vet.App. 128 (1997). In Coh en , the Court held that th e D SM -IV cri teria w ill be co ns ide redin making the i nitial dete rminat ion of ser vice connect ion for PTSD, but that onc e service connection is grante d, the diagnostic code "will be for applicati on to establ ish the appr opriate di sabilit y rating." 10 Vet.App. at 152. As stated a bove, the evi de nc e considered i n determi ning the leve l of impair ment under § 4.130 is not r estric ted to the s ymptoms pr ovided in the di agnostic code . Instead, the rati ng speciali st is t o co nside r all sym ptoms of a c laimant 's condition t hat affe ct the le vel of occupational and social i mpairm ent, includi ng, if appli cable, those identifi ed in the DSM-IV. Se e 38 C. F. R. § 4. 12 6 (20 01 ). If the evid en ce de mon str ate s that a clai man t suf fer s sympto ms or

eff ect s that caus e o ccu pa tio na l or so cia l impa irm en t e qu iva len t to wh at w ou ld b e caus edby the sy mpt oms listed i n the diagnost ic code, the a ppropriat e, equivalentrating wil l be assigne d. Further, as t he Secretar y accurate ly points out , the idea of eva luating PTSD under a rating formul a se parat e fr om tha t fo r othe r me nta l di so rde rs w as s pe cif ica lly co ns ide redan d re

jec tedwh en 38 C. F. R. §§ 4. 16 an d 4 .1 25 thr ou gh4. 13 2 w ere ame nd edin 1 99 6. Th e p ortionof the Fe de ral Re gis ter that re co rds the ame nd men t pr oc ess rea ds : On e co mme ntator

s ug ge ste d that w e ev alu ate [P TS D] n ot un de r a gen era l rating f ormula f or mental disorders but under a sepa rate fo rm ula based on the frequency of

symptoms pa rticul ar to PTSD, i.e., nightm ares, fl ashback s, troubli ng int rus ive mem ori es, un co ntr oll ab le r ag e, an d s tartle res po ns e. Th e d is ti n c ti v e P T S D s y mp to ms l is te db y th e c o mm e n tato r are u s e dto diagnose PTSD rather t han evaluate the deg re e of d isabili ty result ing from t he9

condition. Alt hough certai n sy mp to ms mustbe present i n order to es tablish t he dia gn os is o f P TS D, a s wi th oth er co nd iti on s it is no t the sy mpt oms , b ut the ir e ffe cts , that dete rmine t he l evel of impai rment. For e xample, itis not the pr esence of "flashba cks," per se , but theireffects, such as impair ed impulse control, anxi ety, or dif fic ulty a dapti ng to s tre ssf ul situat ion s, that de termin e th e ev alu ati on . W e h av e, therefor e, made no changes based on this s uggestion. 61 Fe d. Re g. 5 2, 69 5, 5 2, 69 7 (O ct. 8 , 19 96 ). Th e fac t that the re gu lationis w rittenwi th this bu ilt -in versati lity does notmake it i nconsistentwith the underl ying statut e. Se e Ch evron U.S.A. , In c. v. Natural Res. Def. Council, I nc ., 46 7 U .S . 8 37 , 8 43 -44 (19 84 ) (" If C on gre ss h as ex pli cit ly lef t a g ap for the ag en cy to f

ill , th ere is a n e xp res s d ele gatio n o f au tho rity to the ag en cy to elu cid ate a sp eci fic provision of

the stat ute by regula tion. Such legi slative regulati ons are given c ont ro ll ing weight

un les s th ey are arb itr ary , c ap ric iou s, or man ife stl y co ntr ary to the statute .") . We the ref ore rej ect that part of Mr . Mauerhan's ar gument thatthe DSM-IV crit eria shoul d be the exclus ive basis i n the sch ed ule go ve rni ng rating s fo r PTSD and hol d th at § 4. 13 0 "i s a r eas on ab le a ndpe rmi ssi ble construct ion" of 38 U.S.C. § 1155. See Gallegos v. Pri ncipi , 28 3 F .3 d 1 30 9, 13 14 (F ed . C ir. 20 02 ). In its d eci sio n, th e Bo ardre cit edth e 3 0% an d 50 % r ati ng c rit eri a for me ntal disorders , discussed other symptoms Mr. M auerhan displayed, and deci ded tha t the medi cal evidenc e did not show that Mr. Ma uerhan's PTSD was of a degree t hat warrants a 50% rating. R. at 11. Specific ally, the Board set f

orth his sym ptomatol ogy as reported in t he September1998 and April 1999 tr eatment reports f rom the Vet Cent er, the Janua ry 1999 and May 1999 VA compensat ion a nd pension

ex ami natio n re po rts , w hic h re lat edsy mpt oms b o thin s id e a n do u ts id e th e sp eci fic rating cri teria u sed in § 4.130, and the dia gnoses provided by t he examiner s. Id. Contrary to Mr. Mauerhan's argument that th e B oard l imi tedits co nsiderat ionex clu siv ely to the fac tor s sp eci fie d inthe rating sch ed ule , the Bo ardinc lud edin it s ana lys is a di scu ssi onof evi de nc e ref lec tin g th at h e su ffe rs f

rom sy mpt oms
su chas tho ug hts of a

fore sh ort en edfutu re, whi chis a DS M-I V crite rio n for dia gn os is a ndmay eff

ect occupational and social i mpairm ent, but is notlisted under eitherthe 30% or 50% rating. R. at 12. Therefore, although Mr. Mauerhan is correctthat the B oard may look a t crit eria outs ide of the r ating code in deter mining the level of oc cupational and social i mpairm ent, it ca nnot be said t hat the Board, in this ca se, limi ted its analysi s solely to whether he exhibited symptom s liste d in the 30% and 50% rating lev els . Alth ou ghthe B oard ac kn ow led ge d th at M r. M au erh ando es h av e "s ome dif fic ulty in establi shing and mai ntaining ef fective work and social r elations hips," it found tha t his im pairment do es no t warra nt th e 50 % rati ng , b ase d inpart o n h is a bil ity to m ain tai n a

24 -ye ar r elatio ns hip wi th10

his partne r, contactwith his c hildren, and nine and one-half years of em ployment athis then-c urrent job . R . a t 11 ; see 38 C.F .R . § 4. 13 0, DC 94 40 . B ecaus e th e B oard, in d ete rmi nin g th at M r. Mau erh an 's PTS D mo re cl os ely rese mbl eda 30% le ve l of imp airmen t du e to his ab ili ty t o ma int ain some socia l and occupati onal rela tionships, ba sed its de ci si on on all of hi s symptoma tology, a plaus ibl e b asi s inthe rec ordex ist s fo r the Nov emb er 20 00 deci sio n an d th ere for e th at d eci sio n w as not clear ly erroneous

. See Caluza v. Brown , 7 Vet.App. 498, 506 (1995), aff'd per cur iam , 78 F.3d 60 4 (F ed . C ir. 19 96 ) (t ab le)

.

III . C ON CL US ION After co ns id era tion of the pleadings and a rguments of the parti es, and upon revie w of the

rec ord , th e C ou rt h old s th at M r. M au erh anha s n ot d emo ns tratedthat th e B oard c omm itt edeithe r legal or f actual er ror thatwould warrant re versal orrema nd

. T he Co ur t is also sa tisfi ed that the Board's decisi on fulfil ls the "r easons or base s" requir ements of 38 U.S.C. § 7104(d)(1). The decision of

the Board is AFFIRMED.