Citation NR: 9610908 Decision Date: 04/17/96 Archive Date: 04/25/96 DOCKET NO. 93-22 427 ) DATE ) ) On appeal from the Department of Veterans Affairs (VA) Regional Office in Columbia, South Carolina THE ISSUE Entitlement to an increased rating for paranoid schizophrenia, evaluated as 70 percent disabling. (The matter involving entitlement to reimbursement or payment for the cost of the veteran’s unauthorized private hospitalization from February 7, to February 19, 1992, has been addressed in a separate decision.) REPRESENTATION Appellant represented by: Disabled American Veterans WITNESSES AT HEARINGS ON APPEAL Appellant and his mother ATTORNEY FOR THE BOARD W. Pope, Counsel INTRODUCTION The veteran had active service from February 1971 to September 1976, and from November 1980 to June 1981. This matter came before the Board of Veterans' Appeals (Board) on appeal from a May 1992 hearing decision of the VA Regional Office in Columbia, South Carolina (RO). The veteran and his mother were present for hearings before a hearing officer at the RO in February 1992 and before a member of the Board at the RO in August 1993. CONTENTIONS OF APPELLANT ON APPEAL The veteran contends that his paranoid schizophrenia, his only service-connected disability, is productive of greater impairment than reflected by the 70 percent disability rating currently assigned and prevents him from maintaining gainful employment. DECISION OF THE BOARD The Board, in accordance with the provisions of 38 U.S.C.A. § 7104 (West 1991 & Supp. 1995), has reviewed and considered all of the evidence and material of record in the veteran's claims files. Based on its review of the relevant evidence in this matter, and for the following reasons and bases, it is the decision of the Board that the preponderance of the evidence is in favor of a 100 percent rating for the veteran's paranoid schizophrenia. FINDINGS OF FACT 1. All relevant evidence referable to the current appeal has been requested by the RO. 2. The veteran's service-connected paranoid schizophrenia is productive of severe impairment of social and industrial adaptability. 3. The veteran's paranoid schizophrenia, his only service- connected disability, precludes him from engaging in substantially gainful employment. CONCLUSION OF LAW A 100 percent rating for the veteran's service-connected paranoid schizophrenia is warranted. 38 U.S.C.A. §§ 1155, 5107, 7104 (West 1991 & Supp. 1995); 38 C.F.R. §§ 4.16(c), 4.132, Code 9203 (1995). REASONS AND BASES FOR FINDINGS AND CONCLUSION Initially, the Board notes that the veteran's claim is well- grounded within the meaning of 38 U.S.C.A. § 5107, and that all relevant facts have been properly developed for this appeal. Disability evaluations are determined by the application of a schedule for disabilities. Separate Diagnostic Codes identify the various disabilities. 38 U.S.C.A. § 1155; 38 C.F.R. § Part 4. A February 1986 rating decision established service connection for paranoid schizophrenia and assigned a 30 percent disability rating, effective from January 11, 1984, the date of receipt of the veteran’s claim. Paranoid type schizophrenia is evaluated under Diagnostic Code 9203 of the VA rating schedule which provides a 30 percent rating for active psychotic manifestations of such extent, severity, depth, persistence or bizarreness as to produce definite impairment of social and industrial adaptability. A 70 percent rating is assigned for active psychotic manifestations which produce severe impairment of social and industrial adaptability. A 100 percent scheduler rating is warranted for active psychotic manifestations of such extent, severity, depth, persistence or bizarreness as to produce total impairment of social and industrial adaptability. 38 C.F.R. § 4.132, Code 9203. The veteran was hospitalized at a non-VA psychiatric facility on June 15, 1990, with symptomatology including auditory hallucinations and ideas of reference. It was noted that it was his tenth admission to that psychiatric facility for mental illness since January 1983. He was transferred to a VA hospital on June 22, 1990, with a diagnosis of chronic undifferentiated type schizophrenia. During hospitalization at the VA facility he was stabilized on a 15 mg (milligram) dose of Haldol. Cogentin was added to control Haldol side effects. The veteran was discharged on July 6, 1990, with instructions to remain on his medication and to return to the clinic on July 25, 1990, when his next injection of Haldol Decanoate 200 mg IM (intramuscular) would be due. A February 1991 VA psychiatric examination noted the veteran’s history of repeated hospitalizations for paranoid psychosis. The veteran’s affect was markedly flattened. He was mildly suspicious, relatively isolated socially, and did not handle stress well. The impression was paranoid schizophrenia. The examiner added that the veteran was moderately to severely disabled from this psychiatric illness. On August 6, 1991, the veteran was hospitalized at a VA facility for three weeks with reported auditory hallucinations and inability to sleep at night. He felt that people were out to get him and were putting rat poison in his food. He experienced thought broadcasting and thought insertion. He was placed on 15 mg. of Haldol p.o. (by mouth) b.i.d. (twice daily) and one mg of Cogentin p.o. b.i.d. His behavior stabilized by August 19. The diagnoses were undifferentiated schizophrenia, alcohol dependence and alcohol withdrawal delirium. The veteran and his mother were present for a hearing before a hearing officer at the RO on February 6, 1992. The veteran testified that voices told him that the doctors were plotting to kill him; the doctors gave him the wrong medication to prevent him from sleeping at night, and; the voices were mostly present at night. The veteran’s mother testified that the veteran followed her around the house at night and constantly talked about senseless things, even continuing to talk outside the door when she was in the bathroom and over her bed when she was trying to sleep. Upon questioning she stated that the veteran threatened himself more often than he threatened her. The veteran was hospitalized at a non-VA psychiatric facility on February 6, 1992, with increased auditory hallucinations and suicidal ideation. The diagnosis was undifferentiated type schizophrenic disorder. It was noted that it was his eleventh admission to that psychiatric facility for mental illness since January 1983. Because of his complaints about his medication, he was switched to 25 mg. of Loxitane b.i.d. and 2 mg. of Cogentin h.s. (at bed time). The veteran was transferred to a VA hospital on February 19, 1992, with medications consisting of 50 mg. of Loxitane p.o. q.h.s. (every night) and 2 mg. of Cogentin q.h.s. He denied hallucinations or ideation on this regimen. He was discharged on March 2, 1992. During a VA psychiatric examination on March 12, 1992, the veteran reported that he lived with his mother and that she wanted him to move out, but he did not feel that he would be able to maintain himself alone. He stated that most of his problems arose from hearing voices that told him he was useless, etc., and from fear that others were out to kill him or take him away when he was alone. He also stated that he watched television and “it watches me.” The diagnosis was paranoid type schizophrenic disorder. An April 1992 hearing officer’s decision stated that the veteran’s service-connected paranoid schizophrenia was productive of severe impairment both socially and occupationally, and warranted a 70 percent disability rating. A May 1992 rating decision, in accordance with the hearing officer’s decision, assigned a 70 percent disability rating for the veteran’s service-connected paranoid schizophrenia, effective from October 4, 1990, the date of receipt of the veteran’s claim. The veteran was hospitalized at a VA facility for approximately 40 days beginning on June 18, 1992, after assaulting his mother and damaging her house. The veteran indicated that he thought his mother had been stealing his money and he had been thinking of killing her. His mother asserted that the veteran had been laughing inappropriately; “talking out of his head”; abusing alcohol, and; not taking his psychotropic medication. Although the veteran denied auditory or visual hallucinations, nursing notes reported auditory hallucination and ideas of reference from television. On June 30, he was started on 150 mg. Haldol Decanoate IM, and Loxitane was titrated downwards. He was sent out on pass for several days in July to locate an apartment, but upon return to the hospital stated that he did not find a place and had bought a bedroom suite with the intention of returning to live with his mother. His discharge medication was 150 mg. Haldol Decanoate IM every 28 days and continuation of Cogentin. As noted above, the veteran and his mother were present for a hearing before a member of the Board at the RO in August 1993. The veteran indicated that he had last held a job in the early 1980’s, working in a warehouse; he had earned an Associate’s Degree in Accounting, but had never worked in that field; had been receiving disability benefits from the Social Security Administration (SSA) since approximately 1987; was unable to operate machinery, had difficulty counting, etc., because of his medications; spent most of his day watching television, and; lived with his only friend, his mother. The veteran’s mother stated that the veteran had been living with her since 1989; was unable to go anywhere unless she took him; spent his days sleeping and watching television, and; would stand and march in place approximately once a day. Numerous documents and medical evaluations, received from the SSA in September 1993, indicated that the veteran had been granted disability benefits prior to June 1989, due to his diagnosed schizophrenia. Upon review of the medical evidence the Board finds that the veteran's paranoid schizophrenia is manifested by a variable level of symptomatology, centered around episodes of auditory hallucinations and paranoia, which produce anti-social behavior and isolation. The record is replete with references to difficulties the veteran has socializing with anyone except his mother. In our opinion, the record as it is currently constituted is indicative of severe impairment, although not total inadaptability, thereby warranting the 70 percent rating currently assigned under Diagnostic Code 9203. In cases in which the only compensable service-connected disability is a mental disorder assigned a 70 percent evaluation, and the mental disorder precludes the veteran from securing or following a substantially gainful occupation, a 100 percent scheduler evaluation under the appropriate diagnostic code, rather than a total disability rating based on unemployability, is for application. 38 C.F.R. § 4.16(c). A review of the veteran's educational background discloses an Associates Degree in Accounting, which has never been utilized. His employment record reflects an inability to perform any type of work during the last decade, except manual labor for short, sporadic periods. He asserts, essentially, that his employment prospects are nil. His history of social difficulties is well documented, as is his history of repeated hospitalizations for schizophrenia. In short, the medical evidence of record fails to contradict the conclusion that the veteran is unable to work due to paranoid schizophrenia, his sole service-connected disability. Under these circumstances, the preponderance of the evidence supports the assignment of a 100 percent schedular rating under the terms of 38 C.F.R. § 4.16(c). The benefit of the doubt has been resolved in the veteran's favor. 38 U.S.C.A. § 5107. ORDER A 100 percent schedular evaluation for paranoid schizophrenia is granted, subject to controlling regulations applicable to the payment of monetary benefits. JAMES R. ANTHONY Member, Board of Veterans' Appeals The Board of Veterans' Appeals Administrative Procedures Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, 741 (1994), permits a proceeding instituted before the Board to be assigned to an individual member of the Board for a determination. This proceeding has been assigned to an individual member of the Board. NOTICE OF APPELLATE RIGHTS: Under 38 U.S.C.A. § 7266 (West 1991 & Supp. 1995), a decision of the Board of Veterans' Appeals granting less than the complete benefit, or benefits, sought on appeal is appealable to the United States Court of Veterans Appeals within 120 days from the date of mailing of notice of the decision, provided that a Notice of Disagreement concerning an issue which was before the Board was filed with the agency of original jurisdiction on or after November 18, 1988. Veterans' Judicial Review Act, Pub. L. No. 100-687, § 402, 102 Stat. 4105, 4122 (1988). The date which appears on the face of this decision constitutes the date of mailing and the copy of this decision which you have received is your notice of the action taken on your appeal by the Board of Veterans' Appeals. - 2 -