Citation Nr: 18150991 Decision Date: 11/16/18 Archive Date: 11/16/18 DOCKET NO. 16-37 441 DATE: November 16, 2018 ORDER Entitlement to a disability rating of 70 percent, but no higher, for posttraumatic stress disorder (PTSD) is granted. FINDING OF FACT Throughout the period on appeal, the Veteran’s PTSD has resulted in occupational and social deficiencies in most areas. CONCLUSION OF LAW The criteria for a rating of 70 percent, but no higher, for PTSD have been met for the entire period on appeal. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.126; 4.130, Diagnostic Code 9411. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served in the United States Army from July 1966 to March 1969. During that time, he served in the Republic of Vietnam. This case comes to the Board of Veterans’ Appeals (Board) from a February 2013 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). 1. Entitlement to a rating in excess of 50 percent for PTSD A disability rating is determined by the application of VA’s Schedule for Rating Disabilities (Rating Schedule), 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and their residual conditions in civil occupations. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Where there is a question as to which of two evaluations shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. 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. Fenderson v. West, 12 Vet. App. 119, 126-27 (1999); Hart v. Mansfield, 21 Vet. App. 505 (2007). The Veterans service-connected PTSD is evaluated under 38 C.F.R. § 4.130, Diagnostic Code 9411 as 50 percent disabling. He asserts that a higher rating is warranted. PTSD is rated under the General Rating formula for Mental Disorders. See 38 C.F.R. § 4.130, Diagnostic Code 9411. Under these criteria, 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 complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships. A 70 percent rating is warranted where there is 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. A 100 percent rating is warranted where there is 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. In addition, when evaluating a mental disorder, the rating agency shall consider the frequency, severity, and duration of psychiatric symptoms, the length of remissions, and the veteran’s capacity for adjustment during periods of remission. 38 C.F.R. § 4.126(a) (2018). The rating agency shall assign an evaluation based on all the evidence of record that bears on occupational and social impairment rather than solely on the examiner’s assessment of the level of disability at the moment of the examination. Id. However, when evaluating the level of disability from a mental disorder, the rating agency will consider the extent of social impairment, but shall not assign an evaluation on the basis of social impairment. 38 C.F.R. § 4.126(b). Accordingly, the evidence considered in determining the level of impairment under § 4.130 is not restricted to the symptoms provided in the Diagnostic Code. Instead, VA must consider all symptoms of a claimant’s condition that affect the level of occupational and social impairment, including, if applicable, those identified in the Diagnostic and Statistical Manual of Mental Disorders. The Veteran’s treatment records include psychiatric treatment in August 2011. At that time, the Veteran reported getting about 5 to 6 hours of sleep a night. He noted that his anxiety is stable but significant. His wife stated that he wanders around the house and checks things and the Veteran described himself has hypervigilant. On observation, he was oriented times four, had good grooming and hygiene, and was cooperative. His mood and affect were mildly anxious and euthymic, his memory and concentration were adequate and his insight and judgment were fair. He was hospitalized in September 2011 for about 2 weeks related to his psychiatric symptoms. The Veteran was afforded a VA examination in April 2012. At that time, the examiner noted the Veteran’s diagnoses of PTSD and psychotic disorder not otherwise specified (NOS). The examiner found it possible to differentiate which symptoms were attributable to each diagnosis, noting that his psychotic disorder NOS caused a history of psychotic symptoms including auditory and visual hallucinations, paranoid ideation, and delusional thinking. The Veteran’s PTSD appeared to have a mild impact on social and occupational functioning. The Veteran reported being married for 27 years and having 2 adult children. His relationship with his children was good and he noted seeing them weekly. He also indicated that he talked to or got together with friends once every couple of months. He stated that he stopped working in 1987 as he was fired for taking too much time off from work. The Veteran reported feeling down, sad, or blue every day. His level of interest in things was reportedly less and his energy level low most days. He denied having any significant problems with memory but described mild problems with attention or concentration. He reported having suicidal ideation but had no plan or intent to follow through. He denied homicidal ideation. The Veteran reported panic attacks a couple of times per year and stated he had no major problems with hygiene or self-care. A June 2013 statement from the Veteran’s spouse notes that they had been married for 29 years. She noted the Veteran’s nightmares that woke them both up regularly and the Veteran’s fears of socializing with unknown people. She indicated that he was sensitive to loud noises and different smells and how he would isolate himself from even his family. The Veteran reported symptoms including suicidal ideation, occupation and social impairment with reduced reliability and productivity, efforts to avoid thoughts, activities, or people associated or triggering recollections of the trauma, diminished interest or participation in significant activities, difficulty falling or staying asleep; difficulty concentrating; hyper-vigilance; depressed mood; anxiety; panic attacks that occur weekly or less often; chronic sleep impairment. See Notice of Disagreement (June 20, 2013). The Veteran was again hospitalized for several weeks in 2013 due to “bizarre behavior” reported by his family. This behavior included hoarding pots and pans and cutlery in his bedroom, general disorganization, making threats to his wife, and pushing his adult daughter down the stairs. The Veteran’s most recent VA examination was in February 2016. The examiner indicated the Veteran was diagnosed with PTSD and schizoaffective disorder of the bipolar type, in full remission. The examiner stated that there was no unequivocal evidence that PTSD would cause schizoaffective disorder and that it was possible to differentiate the symptoms attributed to each mental health condition. Specifically, the examiner stated that the Veteran’s PTSD included symptoms of depressed mood, anxiety, panic attacks more than once a week, near-continuous pack or depression affecting the ability to function independently, and persistent delusions or hallucinations. The examiner opined that the Veteran’s level of occupational and social impairment with regards to all mental diagnoses was total occupational and social impairment. He was unable to differentiate which portion of the occupational and social impairment was caused by each disorder. The Veteran remained married to his wife of 32 years and had 2 adult children, describing his relationship with them as close. He also noted having a few friends who he saw routinely and belonging to a couple organizations. He played guitar in his spare time. The examiner noted his hallucinations and delusions are currently in remission due to his medication. He was also screened for suicidal ideation and such was ruled out. After a review of the above, the Board finds that a rating of 70 percent for the Veteran’s PTSD is appropriate. The Veteran’s PTSD symptoms represent social and occupational impairment in most areas. The medical evidence shows a history of suicidal ideation, delusions, and hallucinations. Records indicate he has not worked in three decades and the most recent VA examiner found his PTSD productive of near-continuous pack or depression affecting the ability to function independently. Additionally, his wife has reported obsessive and ritualistic behavior and noted his difficulty in adapting to stressful circumstances. The Board finds that these symptoms support a rating of 70 percent for PTSD. The Board further finds, however, that a rating in excess of 70 percent is not warranted at any time during the appeal period. While the Veteran’s symptoms are severe, there is no evidence of total occupational and social impairment. Indeed, the Veteran has maintained an over-30-year marriage and described his relationship with his children as good. Additionally, he reportedly saw friends monthly and joined community groups. He has not demonstrated symptoms of gross impairment in thought processes or communication; he is not considered a persistent danger of hurting self or others; he presents with good hygiene and can function independently; and shows no disorientation to time or place nor memory loss for names of close relatives or his own name. In view of the above, the Board finds that his occupational and social impairment is most accurately contemplated by a 70 percent disability rating. (Continued on the next page)   Accordingly, the Board finds that a 70 percent disability rating, but no higher, is warranted for the Veteran’s service-connected PTSD for the entire period on appeal. Lindsey M. Connor Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Stuedemann, Associate Counsel