Citation Nr: 18150623 Decision Date: 11/15/18 Archive Date: 11/15/18 DOCKET NO. 14-28 575A DATE: November 15, 2018 REMANDED Increased rating higher than 50 percent for PTSD is remanded. REASONS FOR REMAND The Veteran served honorably from January 1979 to January 1999. This matter comes before the Board of Veterans’ Appeals (Board) from an August 2012 rating decision from the Department of Veterans Affairs (VA) Regional Office (RO). Service connection for post-traumatic stress disorder (PTSD) was granted in an October 2007 rating decision with an effective date of May 2002. The condition was rated as 30 percent disabling. The Veteran successfully claimed an increased rating in September 2009, and PTSD was rated as 50 percent disabling with an effective date of February 2010. In September 2011, the Veteran again claimed an increased rating for PTSD, which was denied in November 2012. The Veteran appealed the Board’s decision to the Court of Appeals for Veterans Claims (Court). In March 2018, the Court remanded the appeal. The appeal has now returned to the Board for further action. Disability evaluations are determined by comparing a Veteran's present symptomatology with criteria set forth in VA's Schedule for Rating Disabilities (Rating Schedule), which is based on average impairment in earning capacity. 38 CRF § Part 4. When a question arises as to which of two ratings apply under a particular diagnostic code, the higher evaluation is assigned if the disability more closely approximates the criteria for the higher rating. 38 C.F.R. § 4.7. The Veteran’s PTSD is currently evaluated as 50 percent disabling under Diagnostic Code 9411, in accordance with the General Rating Formula for Mental Disorders. 38 C.F.R. § 4.130. Under the general rating formula, a 50 percent rating is warranted for 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 compete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships. 38 C.F.R. § 4.130 , Diagnostic Code 9411. A 70 percent evaluation is warranted for 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 actives; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; 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. Id. A maximum 100 percent evaluation is warranted for 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. Id. The Veteran contends that his disability should be rated higher than the current 50 percent rating, as his PTSD symptoms have increased. In a May 2014 C&P examination, the examiner indicated the Veteran had moderate to considerable difficulty securing employment. Since that time, Veteran has submitted evidence that his symptoms have gotten worse. A December 2015 lay statement from the Veteran’s wife reports of increased difficulty for the Veteran to connect emotionally and physically to her and others, social anxiety, sleep disturbances and increased difficulty in crowds and around loud noises. The Veteran works for VA as a shuttle bus driver, and has been having difficulty at work including difficulty concentrating. A January 2017 C&P examination indicated the Veteran has had repeated anxiety attacks brought on by work and interaction with supervisors, has missed an increased number of days at work, has had trouble concentrating, and exhibits hypervigilance. A July 2018 VA examination found that the Veteran has had difficulty with hypertension and erectile dysfunction since he was in Desert Storm. He also has trouble in large crowds and around loud noises. He has difficulties during sleep and experiences night sweats, and has depressed mood and panic attacks. The VA examination does not indicate enough detail regarding the Veteran’s disability as it relates to occupational impairment. Although an impairment is noted, the examiner did not elicit enough information to determine the extent to which the Veteran’s PTSD interferes with his ability to work. The examiner did not elicit information regarding panic attacks at work, the amount of days missed, and symptoms that interfere directly with his ability to perform job duties. The matter is REMANDED for the following action: Schedule the Veteran for an examination by an appropriate clinician to determine the current symptoms of his service-connected PTSD. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran’s disability under the rating criteria. The examiner must attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups as they relate to his ability to work. To the extent possible, the examiner should identify any symptoms and functional impairments due to PTSD alone and discuss the effect of the Veteran’s PTSD on any occupational functioning. If it is not possible to provide a specific measurement, or an opinion regarding flare-ups, symptoms, or functional impairment without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). M. H. HAWLEY Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Drew Kelly, Associate Counsel