Citation Nr: 18148091 Decision Date: 11/07/18 Archive Date: 11/06/18 DOCKET NO. 17-04 700A DATE: November 7, 2018 ORDER An initial rating of 70 percent, but no higher, for posttraumatic stress disorder (PTSD) is granted effective April 14, 2014. FINDING OF FACT The Veteran’s PTSD was manifested by occupational and social impairment with deficiencies in most areas. CONCLUSION OF LAW The criteria for an initial rating of 70 percent, but no higher, effective April 14, 2014, are met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.130, Diagnostic Code (DC) 9411. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from April 1964 to July 1968. Disability evaluations (ratings) are determined by evaluating the extent to which a veteran’s service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, including employment, by comparing the symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). 38 U.S.C. §§ 1155; 38 C.F.R. §§ 4.1, 4.2, 4.10. In evaluating a disability, the Board considers the current examination reports in light of the whole recorded history to ensure that the current rating accurately reflects the severity of the condition. The Board has a duty to acknowledge and consider all regulations that are potentially applicable. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). The medical as well as industrial history is to be considered, and a full description of the effects of the disability upon ordinary activity is also required. 38 C.F.R. §§ 4.1, 4.2, 4.10. In a claim for a greater original rating after an initial award of service connection, all the evidence submitted in support of the Veteran’s claim is to be considered. See Fenderson, 12 Vet. App. 119 (1999). The Veteran’s mental health disability is currently rated under DC 9411. Under DC 9411, a 50 percent evaluation for PTSD requires 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. A 70 percent rating is prescribed when there is evidence of 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); and inability to establish and maintain effective relationships. A 100 percent rating is prescribed when there is evidence of 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 as to time or place; and memory loss for names of close relatives, own occupation, or own name. The list of symptoms under the rating criteria are meant to be examples of symptoms that would warrant the rating, but are not meant to be exhaustive, and the Board need not find all or even some of the symptoms to award a specific rating. Mauerhan v. Principi, 16 Vet. App. 436, 442-3 (2002). However, a veteran may only qualify for a given disability rating under § 4.130 by demonstrating the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration, and that such symptoms have resulted in the type of occupational and social impairment associated with that percentage. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 117-18 (Fed. Cir. 2013). In his October 2015 notice of disagreement (NOD), the Veteran indicated he wanted his PTSD to be rated as 70 percent disabling. The Veteran’s PTSD had previously been rated as 50 percent disabling. In a November 2016 rating decision, the RO granted an increased rating for the Veteran’s PTSD to 70 percent effective November 15, 2016. Therefore, the Board is first addressing whether an increased rating is warranted for the time prior to November 15, 2016. After review of the Veteran’s record, the Board finds a 70 percent rating, but no higher, is warranted for the period prior to November 15, 2016. The Veteran was seen for his mental health in November 2014. The examiner observed the Veteran had difficulty communicating his thoughts spontaneously. and was reluctant to talk to his family and friends about his experience in service. The examiner also noted the Veteran had a flattened affect, impoverished speech, but did not have paranoid ideations or hallucinations. Furthermore, the examiner found the Veteran’s thinking was goal directed and logical, albeit blocked. The Veteran was guarded, hypervigilant, and had difficulty concentrating. The Veteran reported having nightmares, anxiety, depression, anger, and poor sleep. In regards to his work, the Veteran reported he could be really hard on people for no apparent reason. The Veteran reported he had suicidal ideations in the past but did not have any at present. The Veteran denied homicidal ideations, obsessional thinking or ritualistic behavior. The Veteran was afforded an examination for his PTSD in March 2015. The March 2015 examiner opined the Veteran’s mental health lead to occupational and social impairments with occasional decreases in work efficiency and intermittent periods of inability to perform occupational tasks, although generally functioning satisfactorily, with normal routine behavior, self-care, and conversation. The Veteran’s symptoms included depressed mood, anxiety, suspiciousness, panic attacks that occurred weekly or less often, chronic sleep impairments, mild memory loss, flattened affect, and difficulty in establishing and maintaining effective work and social relationships. In October 2016, the Veteran reported symptoms such as sleep impairment, concentration issues, and hypervigilance. An examiner also stated the Veteran used to be part of a motor club but no longer participated. After reviewing the evidence of record as a whole, the Board finds the Veteran’s PTSD prior to November 15, 2016 more closely approximate those warranting a 70 percent disability rating. The Veteran has had noted trouble with speech and has suffered from suicidal thoughts. The Veteran has also expressed anxiety in stressful situations, snapping at co-workers for no apparent reason. Additionally, even though the Veteran has been reluctant to speak about his condition, examiners have found the Veteran suffers from nightmares, avoidant thoughts, withdrawing socially, and concentration problems. The Board has reviewed the Veteran’s entire record and has determined a higher 100 percent rating is not warranted for any period on appeal because the evidence does not show the Veteran suffers from total occupational and social impairment. The record does not show the Veteran is not able to interact with people at all in a social or work setting due to his PTSD. As discussed above, the Veteran does not have symptoms approximating gross impairment in through processes, persistent delusions or hallucinations, grossly inappropriate behavior, or disorientation to time or place. Regarding all the above, the Board acknowledges the Veteran’s statements that his mental health causes him problems, including trouble sleeping, anger issues, depression, and anxiety. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). It is clear the Veteran’s PTSD bothers him a great deal, which is the basis for the ratings above. If his mental health did not cause him problems, there would be no basis for compensable ratings, or the increased ratings, the only question is the degree. Neither the Veteran nor his representative has identified any other rating criteria that would provide a higher rating or an additional rating. However, the potential applications of various provisions of Title 38 of the Code of Federal Regulations (2016) have been considered as required by the holding of the Court in Schafrath v. Derwinski, 1 Vet. App. 589, 593 (1991). (Continued on the next page)   Regarding all the above, the Board has considered the applicability of the benefit of the doubt doctrine. Because the preponderance of the evidence is against the Veteran’s claim, the benefit of the doubt doctrine does not apply. See 38 U.S.C. §5107(b); Gilbert v. Derwinski, 1 Vet. App. 49, 55-57(1990). John J. Crowley Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Snoparsky, Associate Counsel