Citation Nr: 18142433 Decision Date: 10/15/18 Archive Date: 10/15/18 DOCKET NO. 16-15 659 DATE: October 15, 2018 ORDER Entitlement to an initial rating in excess of 30 percent for posttraumatic stress disorder (PTSD) is denied. FINDING OF FACT The Veteran’s service connected PTSD is manifested by symptoms productive of functional impairment comparable to no worse than occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks. CONCLUSION OF LAW The criteria for an initial rating in excess of 30 percent for PTSD have not been met. 38 U.S.C. §§ 1155, 5107 (b) (2012); 38 C.F.R. §§ 3.159, 3.321, 4.1-4.14, 4.130, Diagnostic Code 9411 (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active duty service in the Air Force from February 1974 to September 1994. This matter comes before the Board of Veterans’ Appeals (Board) on appeal of a September 2014 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Winston-Salem, North Carolina. Duty to Notify and Assist With respect to the Veteran’s claim herein, VA has met all statutory and regulatory notice and duty to assist provisions. See 38 U.S.C. §§ 5100, 5102, 5103, 5103A, 5106, 5107, 5126 (2012); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326 (2017); see also Scott v. McDonald, 789 F.3d 1375 (Fed. Cir. 2015), Dickens v. McDonald, 814 F.3d 1359 (Fed. Cir. 2016). Legal Criteria – Rating Disabilities Disability ratings are determined by the application of VA’s Schedule for Rating Disabilities, which is based on the average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Pertinent regulations do not require that all cases show all findings specified by the schedule, but that findings sufficient to identify the disease and the resulting disability and above all, coordination of the rating with impairment of function will be expected in all cases. 38 C.F.R. § 4.21; see also Mauerhan v. Principi, 16 Vet. App. 436 (2002). Further, a disability rating may require re-evaluation in accordance with changes in a veteran’s condition. The Board will consider whether separate ratings may be assigned for separate periods of time based on facts found, a practice known as “staged ratings,” whether it is an initial rating case or not. Fenderson v. West, 12 Vet. App. 119, 126-27 (1999); Hart v. Mansfield, 21 Vet. App. 505, 519 (2007). Specific Rating Criteria for Mental Disorders The Veteran’s service-connected PTSD is rated by applying the criteria in 38 C.F.R. § 4.130, Diagnostic Code 9411. The VA General Rating Formula for Mental Disorders reads in pertinent part as follows: 30 percent - 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, and mild memory loss (such as forgetting names, directions, recent events). 50 percent - 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. 70 percent - 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. 100 percent rating - 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 psychiatric symptoms listed in the above rating criteria are not exclusive, but are examples of typical symptoms for the listed percentage ratings. Mauerhan v. Principi, 16 Vet. App. 436 (2002). Accordingly, consideration is given to all symptoms of the Veteran’s PTSD that affect the level of occupational and social impairment. Higher Initial Rating – PTSD The Veteran seeks a higher initial rating for his service-connected PTSD, currently rated at 30 percent disabling. The September 2014 rating decision on appeal granted service connection for PTSD, and assigned a 30 percent initial disability rating effective October 25, 2013. Therefore, the rating period on appeal is from October 25, 2013. 38 C.F.R. § 3.400. Turning to the relevant evidence of record, the Veteran submitted a letter from a private physician, Dr. E.H., dated July 2013. The Veteran reported that he witnessed a crash between two F-16s in 1994 in which several people were killed, he was part of a team that rebuilt a cockpit after a different crash which required him to remove human remains with tongs, and he witnessed the air show disaster at Ramstein, Germany, which resulted in many fatalities. The Veteran reported having nightmares at least 1 or 2 times per week, panic attacks 1 to 3 times per month, and flashbacks with reminders. Dr. E.H. diagnosed PTSD based on the Veteran’s reported stressors. He indicated that the Veteran has intrusive thoughts, startles and angers easily, and is hypervigilant. Dr. E.H. stated that the Veteran had severe short-term memory impairment, some degree of working memory impairment, and occasional depression. The Veteran reported having auditory and visual hallucinations when he is at home alone, such as hearing his name called, or cars coming up the driveway, and seeing shadows, 1 or 2 times per week. The Veteran had a VA examination for PTSD in September 2014. The examiner reviewed the claims file and conducted an in-person examination of the Veteran. She diagnosed PTSD, and summarized the Veteran’s level of functional impairment as occupational and social impairment with occasional decrease in work efficiency and intermittent inability to perform occupational tasks. The Veteran reported having a dysfunctional family during childhood, not having a relationship with his sister or half-sister, being married to his current wife for 24 years, having two adult children, and teaching mechanics full-time at a technical college. The Veteran stated that he enjoys his job, and it allows him to keep in contact with military personnel who frequently take his course. The Veteran was appropriately groomed, polite, cooperative, and showed no signs of psychomotor agitation. The Veteran had a depressed mood, restricted affect, normal speech, logical thought content, no evidence of psychosis, and denied suicidal or homicidal thoughts. The examiner noted the following symptoms: depressed mood, anxiety, chronic sleep impairment, disturbances of motivation and mood, and difficulty adapting to stressful circumstances including in a work or work-like setting. In April 2015, VA received additional medical reports from Dr. E.H dated between July 2013 and February 2015. The reports are summarized below. In July 2013, the Veteran reported nightmares at least 1 or 2 times per week, panic attacks 1 to 3 times per month, and flashbacks with reminders. He had euthymic (normal) mood, linear thought process, memory impairment, normal judgment, normal affect, distractibility, and orientation to time and place. In August 2013, the Veteran denied having any nightmares since starting medication, denied panic attacks, and felt his memory was improving. He had euthymic mood, linear thought process, memory impairment, normal judgement, normal affect, improved concentration, and orientation to time and place. In February 2014, the Veteran reported that his anger and depression were better. He had euthymic mood, linear thought process, memory impairment, normal judgement, normal affect, ability to concentrate, and orientation to time and place. In August 2014, the Veteran reported having occasional visual hallucinations and flashbacks, and high anxiety without panic attacks. He had euthymic mood, linear thought process, normal judgment, normal affect, distractibility, and orientation to time and place. In February 2015, the Veteran denied nightmares, flashbacks, hallucinations, but reported occasional panic attacks. He had euthymic mood, linear thought process, memory impairment, normal judgement, normal affect, ability to concentrate, and orientation to time and place. Dr. E.H. submitted an additional letter in March 2016. He indicated that the Veteran was experiencing nightmares once a month, panic attacks 1 or 2 times per week, intrusive thoughts, impaired short-term and working memory. The Veteran reported feeling depressed sometimes, having low energy, and not socializing at all. Dr. E.H. opined that the Veteran is unable to sustain social relationships, and is moderately compromised in his ability to sustain work relationships. The Veteran submitted a Form 9 in April 2016. He stated that that his PTSD is very severe and he is “barely able to work.” He did not specify how his PTSD symptoms impaired his ability to work, or further explain the severity of his condition. After considering the evidence of record, the Boards find that, for the entire period on appeal, the Veteran’s PTSD manifestations did not rise to the level of severity contemplated by a rating in excess of 30 percent. The evidence of record shows that the Veteran’s PTSD manifested in periods of intermittent depression, chronic sleep impairment, anxiety, panic attacks once a week or more, short and long-term memory impairment, and some degree of difficulty establishing effective social and work relationships. A 50 percent rating is warranted when there is occupational and social impairment with reduced reliability and productivity. In this case, the Veteran did not show symptoms productive of functional impairment comparable: 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. In this regard, the Board attaches high importance to the Veteran’s occupational status during the period on appeal. The Veteran reported working full-time as a teacher, an occupation which necessarily involves interpersonal communication and some degree of social interaction. He indicated that he enjoys his job, and it allows him to keep in touch with other military personnel who frequently take his course. He has not specified how his disability interferes with his occupation. Dr. E.H. indicated a “moderate” level of occupational impairment, and such is contemplated by a 30 percent rating. Even though the September 2014 VA examiner reported that the Veteran had difficulty adapting to stressful circumstances in a work or work-like setting, the evidence of record does not support such severity of occupational impairment. The frequency, severity, and duration of the Veteran’s symptomatology do not support the assignment of a higher rating. See 38 C.F.R. § 4.126 (a). For example, Dr. E.H.’s reports between July 2013 and February 2015 do not indicate depressed mood, disturbances of motivation and mood, or chronic sleep impairment, which contrasts with the findings of the VA examiner. In March 2016, the Veteran stated that he feels depressed “some of the time,” has panic attacks once or twice a week lasting at least 10 minutes, and has nightmares once a month. Such reports suggest mild severity and short duration, and appear consistent with the Veteran’s course of symptomatology over the appeal period. See id. The Board has considered the Veteran’s reports of hallucinations. However, such hallucinations occurred sporadically, not persistently, and appear to have resolved, considering that no hallucinations were mentioned in Dr. E.H.’s most recent reports. After careful consideration, the Board finds that the Veteran’s overall level of functional impairment is most accurately encompassed by a 30 percent rating. Although Dr. E.H. opined that Veteran’s condition made him unable to socialize effectively, the Board may not assign an evaluation solely based on social impairment. 38 C.F.R. § 4.126 (b). The evidence does not suggest the Veteran’s employment was affected by his condition to an extent that would more nearly approximate a higher rating. The Board has considered the Veteran’s contentions that he is entitled to a higher initial rating. The Veteran is competent to report symptoms of his PTSD, as doing so only requires personal knowledge. However, the Veteran has not been deemed to be competent to render an opinion as to the relative severity of his PTSD, as doing so requires specialized medical knowledge or expertise the Veteran has not been shown to possess. See Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011); Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). The Board concludes that, given the medical professionals’ expertise in evaluating mental disorders, the findings of record provided by the medical professionals are more probative than the Veteran’s statements. In sum, the Board finds that a disability rating in excess of 30 percent is not warranted for the Veteran’s service-connected PTSD at any time during the period on appeal. There is no basis for staged ratings, the preponderance of the evidence is against the claim, the benefit of the doubt does not apply, and the claim is denied. See 38 U.S.C. § 5107 (b); Gilbert v. Derwinski, 1 Vet. App. 49, 58 (1990).   Neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record. See Yancy v. McDonald, 27 Vet. App. 484, 495 (2016); Doucette v. Shulkin, 38 Vet. App. 366, 369-70 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). S. L. Kennedy Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD D. Reed, Associate Counsel