Citation Nr: 18141066 Decision Date: 10/09/18 Archive Date: 10/09/18 DOCKET NO. 16-30 534 DATE: October 9, 2018 ORDER Entitlement to a rating in excess of 50 percent for posttraumatic stress disorder (PTSD) is denied. FINDING OF FACT Throughout the period of this claim, the Veteran’s PTSD overall has not been manifest by occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech 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 work like setting); or an inability to establish and maintain effective relationships. CONCLUSION OF LAW The criteria for a rating in excess of 50 percent for PTSD have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. § 4.130, Diagnostic Code 9411 (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from April 1968 to January 1971. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a December 2015 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Fort Harrison, Montana. Entitlement to a rating in excess of 50 percent for posttraumatic stress disorder (PTSD) Disability evaluations are determined by the application of the VA’s Schedule for Rating Disabilities (Rating Schedule). 38 C.F.R. Part 4 (2017). The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and their residual conditions in civil occupations. 38 U.S.C. § 1155; 38 C.F.R. § 4.1 (2017). Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The Veteran claims entitlement to an increased disability rating for his service-connected PTSD, which he asserts is more severe than the 50 percent rating assigned. A 50 percent rating is warranted for PTSD where there is 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 such as, retention of only highly learned material, forgetting to complete tasks; impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships. A 70 percent rating for PTSD contemplates 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 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 work like setting); inability to establish and maintain effective relationships. Finally, a 100 percent disability rating is warranted for PTSD resulting in total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. The evidence considered in determining the level of impairment under the Rating Schedule for PTSD is not restricted to the symptoms provided in the diagnostic code. Instead, VA must consider all symptoms of a claimant’s condition that affect the level of occupational and social impairment. Mauerhan v. Principi, 16 Vet. App. 436 (2002). In a September 2014 VA treatment record, a VA physician noted that the Veteran answered questions appropriately, his speech was normal in content and cadence, and his affect was appropriate. A March 2015 VA treatment record found that the Veteran answered questions appropriately. His speech was normal in content and cadence. There was no suicidal or homicidal ideation. There was also no delusional behavior or thinking; his affect was described as appropriate. An October 2015 VA treatment record noted that the Veteran answered questions appropriately. His speech was normal in content and cadence. There was no suicidal or homicidal ideation. There was no delusional behavior or thinking. Affect was appropriate. The Veteran’s PTSD was stable. In an October 2015 disability benefits questionnaire (DBQ) submitted by the Veteran, a private physician noted the Veteran’s PTSD diagnosis. It was noted the Veteran had never been married and did not have any children. It was also noted he had been unstable in his work history, and that he lacked support as he became more disabled. The private physician determined that the Veteran had occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood. The private physician said that the Veteran had very little prior mental health care and was not on any psychiatric medication. She determined that symptoms associated with the Veteran’s PTSD were the following: depressed mood; anxiety; panic attacks that occurred weekly or less often; chronic sleep impairment; impaired judgment; impaired abstract thinking; difficulty in establishing and maintaining effective work and social relationships; and inability to establish and maintain effective relationships. In an August 2015 private addendum, the private physician said that she felt his reliance on marijuana before he “gave it up,” and his current reliance on drinking had been his form of self-treatment for PTSD. The private physician stated that the Veteran’s adjustments in all walks of life had been seriously affected by his PTSD. He went through his adult years unable to establish a career or a relationship. She stated that now in his forced retirement the Veteran was suffering from bad memories and severe hypervigilance and many other symptoms of PTSD. She said she believed had it not been for his COPD, he probably would have stopped working due to his PTSD, and that at this point he was totally disabled apart from his physical problems. She recommended he receive psychiatric and psychological help from the VA. In a March 2016 private addendum, the private physician stated that the Veteran was at least 70 percent disabled, even 100 percent disabled. The private physician’s rationale was that the Veteran had been declining in his ability to work over many years of his adult life, going downhill from strong business and administrative skills to providing lawn care. He was severely impaired from any ability to work with other people because he was easily triggered in his PTSD symptoms. The private physician stated that when triggered, he flared from irritable to angry, and though he was unlikely to start a physical fight at his age, he was unable to work with others. He had no supportive relationships, not even membership in a PTSD or Alcoholics Anonymous support group. The private physician did not think he could participate appropriate in such a group. He was never able to marry and had no children due to his emotional problems and addictive behaviors. He had poor insight and lacked social judgment. Specifically, during their interview, the Veteran was unable to appropriately gauge what information to share and what was relevant and important, even with repeated requests. The private physician did not find him likely to improve given his age and the chronicity of those issues. In a September 2016 VA examination, the Veteran reported that he remained in contact with his sisters and his mother who had dementia. His father passed away in 2008, but had remained in contact with his father up until the time of his death. He had never been married and had no children. He reported some friendships in the local area. He was an active member with the Veterans of Foreign Wars with regional appointment. He was a member of the Moose Lodge and remained active with them as well. He enjoyed fishing, and said he used to do a lot of backpacking and other hiking but his COPD now prohibited that. He liked to gather medicinal plants and enjoyed going out to eat. The examiner noted the following symptoms associated with the Veteran’s PTSD: depressed mood; anxiety, suspiciousness; disturbances of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships. In an October 2016 addendum opinion, the examiner stated that the Veteran had occupational and social impairment with reduced reliability and productivity. The examiner said that the Veteran communicated in a goal-directed manner during the examination. He displayed reasonable social skills and did not display reactivity to exam questions or other exam tasks. The Veteran did not display any significant difficulties in remembering important personal information needed for the examination. There were no issues with judgment or insight. He was able to think abstractly and did not have any issues with concentration. Overall, the Board finds that the evidence does not show that the Veteran’s PTSD warrants a rating in excess of 50 percent. As stated above, a 70 percent rating for PTSD contemplates 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 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 work like setting); inability to establish and maintain effective relationships. Throughout the record, there was nothing that showed the Veteran suffered from suicidal ideation, obsessional rituals, speech issues, near continuous panic or depression, impaired impulse control, spatial disorientation, or neglect of personal appearance and hygiene. In fact, the record shows that there was no indication of suicidal or homicidal ideation. The Veteran’s speech was consistently logical and goal oriented. There is no indication he was never well groomed or unhygienic. Further, the Veteran was noted to have a good relationship with his sisters and mother, he enjoyed fishing, and going out to eat, and was an active member of the Veterans of Foreign Wars and the Moose Lodge. As the Veteran does not warrant a 70 percent rating, there is no indication that the Veteran suffers from total occupational and social impairment. The Board notes the October 2015 DBQ and subsequent August 2015 and March 2016 private addendums associated with the October 2015 DBQ found the Veteran’s symptoms to warrant a higher disability rating. However, the Board finds that the Veteran’s VA treatment records and VA examinations are more probative. For example, in in the October 2015 DBQ, the examiner indicated that the Veteran’s PTSD results in an inability to establish and maintain effective relationships, but the DBQ does not address the Veteran’s ongoing relationship with his sisters or that he is an active member of the Veterans of Foreign Wars with a regional appointment and is active in the local Moose Lodge. Although the August 2015 and March 2016 private addendums assert that the Veteran’s symptoms are more severe and that he has difficulty with relationships and will become irritable and angry “when triggered,” there is no indication that the Veteran’s disturbances of mood result in occupational and social impairment with deficiencies in most areas. Although the private examiner stated that the Veteran could not participate in AA or a PTSD support group because he cannot work with others, she does not address the Veteran’s active participation and appointment in the VFW or Moose Lodge. Based on these inconsistencies, the Board places greater probative weight on the VA examination report and treatment records. Accordingly, the Board finds that a rating in excess of 50 percent is not warranted for any period of time covered by the appeal. In reaching this decision the Board considered the doctrine of reasonable doubt, however, as the preponderance of the evidence during the appeal period is against the Veteran’s claim for a disability rating in excess of 50 percent for his service-connected PTSD, the doctrine is not for application. Gilbert v. Derwinski, 1 Vet. App. 49 (1990). M. Donohue Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Saudiee Brown, Associate Counsel