Citation Nr: 18154304 Decision Date: 11/29/18 Archive Date: 11/29/18 DOCKET NO. 14-08 411 DATE: November 29, 2018 ORDER Entitlement to a disability rating in 50 percent prior to August 27, 2009, and 70 percent prior to September 9, 2011, for posttraumatic stress disorder (PTSD) with bipolar disorder is granted. FINDING OF FACT For the entirety of the appeals period, the Veteran’s PTSD with bipolar disorder has resulted in near total occupational and social functioning due to such symptoms as violent outbursts, delusional and grandiose thinking, and manic episodes. CONCLUSION OF LAW The criteria for entitlement to a disability rating of 100 percent effective December 7, 2000, for PTSD with bipolar disorder have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.3, 4.7, 4.130, Diagnostic Code 9411. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active duty service from January 1974 to July 1978. Entitlement to a disability rating in 50 percent prior to August 27, 2009, and 70 percent prior to September 9, 2011, for PTSD with bipolar disorder The Veteran seeks an increased initial rating for his service-connected PTSD with bipolar disorder. He asserts this disability results in impairment in social and occupational functioning, and an increased rating is therefore warranted. Disability evaluations are based upon the average impairment of earning capacity as contemplated by the schedule for rating disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. In order to evaluate the level of disability and any changes in condition, it is necessary to consider the complete medical history of the Veteran's condition. Schafrath v. Derwinski, 1 Vet. App. 589, 594 (1991). In adjudicating increased rating claims, the level of disability in all periods since the effective date of the grant of service connection must be taken into account, to include the possibility that a staged rating may be assigned. Hart v. Mansfield, 21 Vet. App. 505 (2007). As such, the Board will consider whether staged ratings are appropriate to the pending appeals. In cases in which a reasonable doubt arises as to the appropriate degree of disability to be assigned, such doubt shall be resolved in favor of the Veteran. 38 C.F.R. § 4.3. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. 38 C.F.R. § 4.7. PTSD is rated under Diagnostic Code 9411, and utilizes the General Rating Formula for Mental Disorders. Under this Code, a 30 percent disability rating is warranted where there is occupational and social impairment with occasional decrease in work efficiency and intermittent periods of an inability to perform occupational tasks (although generally functioning satisfactorily, with routine behavior, self-care, and conversation normal), due to such symptoms as depressed mood, anxiety, suspiciousness, panic attacks, chronic sleep impairment, and mild memory loss. A 50 percent rating is warranted where there is 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 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); and inability to establish and maintain effective relationships. A 100 percent evaluation for a psychiatric disability 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. 38 C.F.R. § 4.130, Diagnostic Code 9411. In evaluating psychiatric disorders, the Board is mindful that the use of the term “such as” in 38 C.F.R. § 4.130 demonstrates that the symptoms after that phrase are not intended to constitute an exhaustive list, but rather are to serve only as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating. Mauerhan v. Principi, 16 Vet. App. 436 (2002). In Vazquez-Claudio v. Shinseki, 713 F.3d 112, 117 (2013), the U.S. Court of Appeals for the Federal Circuit (Federal Circuit) held that VA “intended the General Rating Formula to provide a regulatory framework for placing veterans on a disability spectrum based upon their objectively observable symptoms.” The Federal Circuit stated that “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.” It was further noted that “§ 4.130 requires not only the presence of certain symptoms but also that those symptoms have caused occupational and social impairment in most of the referenced areas.” After considering the totality of the record, the Board finds the evidence suggestive of near total impairment secondary to the Veteran’s PTSD with bipolar disorder. While the Veteran has had periods of near normal behavior, he also regularly experiences episodes of precipitous decline in social and occupational impairment, according to the evidence of record. These episodes have, according to extensive VA and private psychiatric treatment records and examination reports, been characterized by delusional thinking, violent outbursts, and aggressive behavior. A November 2000 letter from R.P., Ph.D. described a marked affective lability with a tendency towards rage responses and fantasies of revenge. During VA psychiatric hospitalization in February 2001, the Veteran was described as “delusional with grandiose thoughts” by a VA psychiatrist. He had been involuntarily committed following threats of violence toward his family, and was exhibiting hypomanic behavior. A September 2005 letter from his Vet Center counselor described nightmares accompanied by “obsessed homicidal ideations” along with paranoia, delusions, and intense anger and rage. The Veteran has also been awarded Social Security disability benefits based on unemployability secondary to his psychiatric symptoms. An April 2001 psychiatric assessment found the Veteran was not able to sustain full time work due to “marked difficulty interacting with others” resulting from psychiatric symptoms characterized as “very severe” by the examiner. Noted symptoms included violent rages, extreme mood swings, and delusions, such as “worms in his eyes.” The Social Security examiner concluded the Veteran’s psychiatric disorders were not treatable at that time and there was “no likelihood of recovery or improvement within the next 12 months.” While the Veteran attempted to return to full time work in 2005, he quickly decompensated and was terminated after several months. According to a February 2009 VA examination report, the Veteran had had a suicide attempt in July 2004, and multiple psychiatric hospitalizations in the past 10 years. These hospitalizations were generally the result of manic episodes of his bipolar disorder, during which time he was delusional, with grandiose ideas, extended periods of excessive energy and lack of sleep, and impulsive behavior. He also had a longstanding history of violence due to his inability to control his anger, resulting in four failed marriages. Additionally, the Veteran had multiple restraining orders against him from his ex-wives. The Veteran’s manic episodes had also resulted in significant occupational impairment, causing him to lose multiple jobs. Most recently, he had not worked for on a regular full-time basis since approximately 2005. (Continued on the next page)   After considering the totality of the record, and in light of 38 C.F.R. §§ 4.3 and 4.7, the Board finds the criteria are met for a 100 percent (total) rating for the Veteran’s PTSD with bipolar disorder for the entirety of the rating period on appeal. As this award is for the entirety of the appeals period, this constitutes a full grant of the benefits sought on appeal. H. SEESEL Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Thomas D. Jones, Counsel