Citation Nr: 18144916 Decision Date: 10/25/18 Archive Date: 10/25/18 DOCKET NO. 16-32 544 DATE: October 25, 2018 ORDER An initial disability rating of 100 percent for posttraumatic stress disorder (PTSD) and attention deficit hyperactive disorder (ADHD) with residuals of a traumatic brain injury (TBI) with dizziness is granted effective February 26, 2013. Special monthly compensation (SMC) at the rate provided by 38 U.S.C. § 1114(s) is granted, effective August 1, 2014. VETERAN’S CONTENTION The Veteran contends that he is entitled to a 100 percent initial rating for his psychiatric disorders with TBI from the beginning of the claim period—February 26, 2013—to present. FINDINGS OF FACT 1. In a January 2013 VA treatment record, the clinician noted that the Veteran had a history of violence and that he was arrested about 6 years prior for pulling a knife on someone. 2. As recorded in a March 2013 VA mental health treatment plan note, the Veteran reported that he was unable to slow down and that he always paced. He stated that his attention was constantly drawn to many different things at the same time. The clinician noted that the Veteran spoke loudly and rapidly, always commenting on and explaining his mental health condition. The Veteran reported that he had many jobs in the past but he could not keep them because he could not keep his opinions to himself. The Veteran admitted to having a confrontational attitude which displeased supervisors. Lastly, the Veteran reported past incidents of violence and being criminally charged with assault with a deadly weapon. 3. In an April 2013 treatment record, Dr. Lasala—a non-VA psychiatrist—noted that the Veteran was inattentive, hyper, distractible, forgetful, and disorganized. In a May 2013 mental status examination, Dr. Lasala noted the Veteran’s fidgeting behavior and stated that the Veteran had poor insight, judgment, and reality assessment. 4. In an April 2014 VA TBI residuals examination, the examiner noted that the Veteran suffered from the following neurobehavioral symptoms: easily irritable; getting in arguments with family members and friends, with physical fights in the past; verbal aggression with family; and impulsive gambling, shopping, and sexual relationships. 5. As recorded in a July 2014 VA mental health clinic note, the Veteran displayed tangential thinking, a constant wandering of thoughts, poor concentration, and easy distraction. The clinician noted that the Veteran had a history of illicit drug use. The Veteran reported feelings of guilt and stated that he had wasted his life. 6. In a March 2015 statement, the Veteran reported severe memory problems, including forgetting the names of good friends whom he had known for 25 years and forgetting the name of the street that he lived on. Additionally, the Veteran stated that he really did not have a thought process and just reacted to events around him. He reported that he had quit or been fired from all prior employment positions as he had angry outbursts at his supervisors and had even threatened to beat up former superiors. Lastly, the Veteran stated that he was ashamed of his behavior and that the only reason he had not been fighting others lately was that other people were intimidated by him. 7. Effective August 1, 2014, the Veteran had a single service-connected disability rated at 100 percent plus additional service-connected disabilities independently rated at 60 percent. CONCLUSIONS OF LAW 1. The criteria for an initial disability rating of 100 percent for PTSD and ADHD with residuals of a TBI with dizziness are been met, effective February 26, 2013. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.124a, 4.126, 4.130, Diagnostic Code 8045-9411. 2. The criteria for SMC at the housebound rate are met, beginning August 1, 2014. 38 U.S.C. §§ 1114(s), 5107(b); 38 C.F.R. §§ 3.102, 3.350(i). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from November 1972 to October 1975. These matters come before the Board of Veterans’ Appeals (Board) on appeal from May 2014 and June 2016 rating decisions of Department of Veterans Affairs (VA) Regional Offices (RO). Jurisdiction of the Veteran’s claims file currently resides with the San Diego, California RO. Initial Disability Rating for PTSD and ADHD with Residuals of a TBI As ordered above, the Board finds that the Veteran is entitled to an initial disability rating of 100 percent for PTSD and ADHD with residuals of a TBI for the entire claim period, beginning February 26, 2013. As such, the Veteran’s appeal is granted. In support of this determination, the Board finds that, throughout the entire claim period, the Veteran’s psychiatric issues produced symptoms analogous to total occupational and social impairment. Specifically, as described in the Findings of Fact section, evidence associated with the claims file demonstrated that the Veteran’s service-connected PTSD and ADHD with TBI residuals caused gross impairment in the Veteran’s thought process, a persistent danger of harming others, and significant memory loss. Such symptoms are indicative of a 100 percent rating under the General Rating Formula for Mental Disorders. See 38 C.F.R. § 4.130. SMC at the Housebound Rate SMC is payable at the housebound rate where the Veteran has a single service-connected disability rated as 100 percent and, in addition: (1) has a service-connected disability or disabilities independently ratable at 60 percent, separate and distinct from the 100 percent service-connected disability, and involving different anatomical segments or bodily systems, or (2) is permanently housebound by reason of service-connected disability or disabilities. 38 U.S.C. § 1114(s); 38 C.F.R. § 3.350(i). In light of the decision to grant an initial 100 percent rating for PTSD and ADHD with TBI residuals with an effective date of February 26, 2013, the Board notes that, per the Veteran’s most recent rating decision codesheet from July 2017, the Veteran had additional service-connected disabilities independently ratable at at least 60 percent—(1) sinusitis at 50 percent, effective May 14, 2014; and (2) obstructive sleep apnea at 50 percent, effective August 1, 2014. As the Veteran met the criteria for SMC at the housebound rate on August 1, 2014, the Board grants this issue as well, in recognition of its obligation to maximize the benefits available to veterans. See Buie v. Shinseki, 24 Vet. App. 242 (2010). (Signature on Next Page) S. C. KREMBS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD N.S. Pettine, Associate Counsel