Citation Nr: 18143761 Decision Date: 10/22/18 Archive Date: 10/22/18 DOCKET NO. 16-19 930 DATE: October 22, 2018 ORDER Entitlement to a rating of 70 percent, but not higher, for posttraumatic stress disorder (PTSD) with depressive disorder, not otherwise specified, for the entire appeal period is granted. FINDING OF FACT For the entire period on appeal, the occupational and social impairment from the Veteran’s PTSD with unspecified depressive disorder has more nearly approximated deficiencies in most areas. CONCLUSION OF LAW The criteria for a rating of 70 percent, but not higher, for PTSD with depressive disorder, not otherwise specified, have been met for the entire period on appeal. 38 U.S.C. § 1155 (2012); 38 C.F.R. §§ 3.102, 4.7, 4.130, Diagnostic Code 9411 (2018). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active air service from September 2001 to October 2003. These matters come before the Board of Veterans’ Appeals (Board) on appeal from a July 2014 rating decision issued by the VA Regional Office. Entitlement to a rating in excess of 50 percent for posttraumatic stress disorder (PTSD) with depressive disorder, not otherwise specified. The Veteran has asserted that symptoms of her PTSD with unspecified depressive disorder are worse than those contemplated by the currently assigned rating. In January 2014, the Veteran underwent a private psychological evaluation. She was married to her second husband. She had a daughter from a previous relationship and a son with her ex-husband. She had been sexually assaulted in the military, but provided no details. She enjoyed spending time with her family, was active in her church, and was currently enrolled in college. She endorsed symptoms of depressed mood, worry, anxiety, panic attacks, loss of interest in and enjoyment of activities, difficulty sleeping, nightmares, lack of energy, inability to concentrate, dissociation and feelings of detachment, restricted range of affect (“numb”), and hypervigilance. She denied any current or past suicidal ideation and/or attempts and reported no homicidal ideation. The Veteran was afforded a VA psychiatric examination in June 2014. The Veteran was currently living with her second husband. She stated that her marriage was “not going well” because her husband was controlling and verbally abusive. In her spare time, the Veteran went out with her husband and her friends. She was currently unemployed but reported no difficulty with her previous jobs, such as disciplinary actions or missed time from work, due to mental health problems. She planned to attend graduate school after college. She endorsed symptoms of depressed mood, anxiety, irritability and hypervigilance around men, chronic sleep impairment, nightmares, intrusive thoughts, avoidant behaviors, suicidal ideations, difficulty in establishing and maintaining effective relationships, and difficulty in adapting to stressful circumstances. The examiner determined that the Veteran had occupational and social impairment with reduced reliability and productivity. In August 2015, the Veteran sought treatment at a private hospital emergency department for worsening symptoms of depression and anxiety. She reported that she had not been sleeping or eating. She described some stressors at home including a difficult step-son, a mother who “stole” her daughter away from her, and a husband who was unsupportive and called her “crazy.” She stated that she had suicidal thoughts and a plan to overdose on her husband’s insulin. She expressed that they were disturbing intrusive thoughts and she had no suicidal intent. She denied any homicidal ideation. In February 2017, the Veteran was provided an additional VA examination. The Veteran was married and lived with her husband, 12-year old son, and 17-year old step-son. Her 14-year old daughter lived with her parents. She reported ongoing emotional abuse from her husband. Her family had “disowned” her. She was currently enrolled in a master’s program. She endorsed symptoms of depressed mood, anxiety, stress, episodic anger, panic attacks, chronic sleep impairment, patterns of avoidance, reactivity to triggering stimuli, hyperarousal with sleep disruption, and disturbances of motivation and mood. The examiner determined that the Veteran had occupational and social impairment with reduced reliability and productivity. A review of VA treatment records show that the Veteran has received additional mental health treatment. However, there is no indication from the record that her symptoms were manifestly different than those already described above. Additionally, the Veteran submitted lay statements describing symptoms similar to that reported above. The Veteran also reported a constant fear of being raped and murdered if she went out at night. She stated that she experienced severe social anxiety and panic with going to school and work, and it caused a decline in her grades and work performance. Her husband also stated that the Veteran had episodes of anger which she claimed homicidal thoughts. The Veteran reported that she occasionally lashed out and hit her husband and kids due to her impulsive anger. Upon review of the record, the Board finds that the Veteran is entitled to a 70 percent rating for the entire period on appeal. In this regard, the Board finds that the Veteran is considered to have occupational and social impairment with deficiencies in most areas. The evidence reflects that the Veteran’s PTSD with unspecified depressive disorder has been manifested by suicidal ideations and plan, anxiety, stress, depression, anger, irritability, panic attacks, chronic sleep impairment, nightmares, intrusive thoughts, isolative and avoidant behaviors, hypervigilance, disturbances of motivation and mood, lack of energy, lack of interest in activities, inability to concentrate, difficulty in adapting to stressful circumstances, and inability to establish and maintain effective relationships. She has experienced difficulty at work and school as a result of her symptoms. Further, the Veteran has been estranged from her parents and does not appear to see her minor daughter. As such, the Board finds that a 70 percent rating for the entire period on appeal is warranted. 38 C.F.R. § 4.130, Diagnostic Code 9411. The Board acknowledges that the results of the VA examinations, mental health treatment records, and the symptoms reported by the Veteran and her husband do not indicate that the Veteran has experienced all of the symptoms associated with a 70 percent rating for PTSD with unspecified depressive disorder. However, the symptoms enumerated under the schedule for rating mental disorders are not intended to constitute an exhaustive list, but rather are intended serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular disability rating. Mauerhan v. Principi, 16 Vet. App. 436 (2002). Accordingly, the Board finds that there is occupational and social impairment sufficient to warrant a 70 percent rating even though all the specific symptoms listed for that rating are not manifested. Consideration has been given to assigning a higher rating for the Veteran’s PTSD with unspecified depressive disorder. However, there is no indication from the record that the Veteran has total occupational and social impairment. In this regard, while the Veteran has experienced some difficulty with work and school, she has maintained enrollment in a Master’s program and there is no indication that she is unable to work. Further, while she does have impairment in her ability to develop and maintain relationships, she does maintain a relationship with her son and is married. She has reported that she enjoys going out with her husband and friends in her free time. Further, there is no indication that she has impairment in speech or thought processes. She is able to maintain her personal hygiene and her mental health symptoms do not appear to impact her ability to perform activities of daily living. Additionally, while she has had some suicidal ideation and her husband has indicated she sometimes expresses homicidal ideations, she does not appear to be a danger to herself or others. Further, there is no indication from the record that the Veteran has had hallucinations, delusions, or obsessive rituals that interfere with her ability to manage daily life. As such, the Board finds that a rating in excess of 70 percent for PTSD with unspecified depressive disorder is not warranted. 38 C.F.R. § 4.130, Diagnostic Code 9411. Consideration has been given to assigning staged ratings. However, at no time during the period in question has the disability warranted a higher schedular rating than that assigned. Hart v. Mansfield, 21 Vet. App. 505 (2007). Kristin Haddock Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD D. Ware, Associate Counsel