Citation Nr: 18156347 Decision Date: 12/07/18 Archive Date: 12/07/18 DOCKET NO. 15-34 469 DATE: December 7, 2018 ORDER Entitlement to a 100 percent rating for post-traumatic stress disorder (PTSD) with depressive disorder and panic disorder is granted. REMANDED Entitlement to special monthly compensation (SMC) for aid and attendance of another person is remanded. FINDING OF FACT Throughout the appeal period the Veteran’s PTSD with depressive disorder and panic disorder has more nearly approximated total occupational and social impairment due to symptoms such as gross impairment of thought processes, memory impairment, inability to concentrate, irritability, angry outbursts of verbal or physical aggressiveness, panic attacks more than once a week, difficulty establishing and maintaining effective relationships, and near continuous panic or depression affecting the ability to function effectively. CONCLUSION OF LAW The criteria for entitlement to a 100 percent rating for PTSD with depressive disorder and panic disorder have been satisfied. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1-4.7, 4.130, Diagnostic Code 9411. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Air Force from October 1985 to October 1989. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a March 2014 rating decision from the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran presented sworn testimony at a hearing before the undersigned in October 2018. PTSD Rating The Veteran seeks a higher initial rating for his service-connected PTSD with depressive disorder and panic disorder (PTSD), which was increased to 70 percent disabling effective July 24, 2013. The Veteran’s PTSD is rated under the General Rating Formula for Mental Disorders. 38 C.F.R. § 4.130, Diagnostic Code 9434-9411. Ratings are assigned according to the manifestation of symptoms and the extent to which they cause occupational and social impairment. See Bankhead v. Shulkin, 29 Vet. App. 10, 18 (2017); see also Vazquez-Claudio v. Shinseki, 713 F.3d 112, 115 (Fed. Cir. 2013). The rating criteria includes a non-exhaustive list of symptoms, meaning that VA is not required to find the presence of all, most, or even some of the enumerated symptoms to assign a particular evaluation. Bankhead, 29 Vet. App. at 18 (quoting Vazquez-Claudio, 713 F.3d at 116-17) (quotations omitted). Thus, a veteran may qualify for a given disability rating by demonstrating that he or she suffers from the particular symptoms associated with that percentage, or others of similar severity, frequency, and duration, and that those symptoms caused the level of occupational and social impairment associated with a particular disability evaluation. Bankhead, 29 Vet. App. at 18; Vazquez-Claudio, 713 F.3d at 116-17. In sum, “VA must engage in a holistic analysis in which it assesses the severity, frequency, and duration of the signs and symptoms of the veteran’s service-connected mental disorder; quantifies the level of occupational and social impairment caused by those signs and symptoms; and assigns an evaluation that most nearly approximates that level of occupational and social impairment.” Bankhead, 29 Vet. App. at 22 (internal citations omitted). Under the General Rating Formula for Mental Disorders, a 100 percent rating will be assigned for total occupational and social impairment due to symptoms such as gross impairment in thought processes or communication, persistent delusions or hallucinations, grossly inappropriate behavior, a persistent danger of hurting herself or others, an intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene), disorientation to time or place, and memory loss for names of close relatives, own occupation, or own name. The Board finds that a 100 percent schedular rating for PTSD is warranted during the appeal period. The evidence of record shows that throughout the appeal period the Veteran’s psychiatric disability has been marked by severe anxiety, panic attacks multiple times a week, gross impairment of thought processes, memory impairment, inability to concentrate, angry outbursts of verbal or physical aggressiveness, irritability, difficulty in adapting to a worklike setting, difficulty in adapting to stressful circumstances, inability to establish effective relationships, disturbances of motivation and mood, chronic sleep impairment, and near continuous panic or depression affecting the ability to function effectively. At the June 2015 VA examination, the Veteran reported having panic attacks at least 3 times a week and cutting himself when he feels numb to his feelings. The June 2015 VA examiner found that based on the Veteran’s PTSD symptoms with panic attacks, he would likely have difficulty interacting with others on a job, difficulty understanding and remembering instructions, and would have difficulty sustaining attention needed for task completion. The examiner further opined that even if he were in a situation where he was loosely supervised and had little interaction with the public, it is likely he would difficulty maintaining a job due to attention problems. The Veteran reported that he has no friends and that he has not worked since 2009. The examiner noted that the Veteran’s level of impairment was best summarized as “total occupational and social impairment.” Additionally, the Veteran’s treating mental health care provider has noted that he is severely impaired as a result of his PTSD symptoms, which interfere with his ability to perform basic activities of daily living. It was noted that his severe anxiety, avoidance response, tendency to misinterpret the motives of others, difficulty in forming trusting relationships, and unhelpful thinking styles have made it difficult for him to appropriately ask for help. See December 2014 VA Treatment Record. It was observed that the Veteran has socially isolated himself from friends and family, and has not made any new friends. He was also noted to have significant problems with memory, including an inability to remember simple instructions, names, telephone numbers, dates, appointments, and to pay bills. He has difficulty performing simple tasks, and becomes very agitated, which triggers flashbacks and angry outbursts. See id. His daughter and roommate have both reported that the Veteran has such a poor memory and thought processes that he will be unable to find his keys when they are in his hand or glasses when they are on his head, and that he constantly need assistance in locating his wallet. See October 2018 Statement of D.B. The Board finds that this level of impairment more nearly approximates total occupational and social impairment, and thus the criteria for a 100 percent rating have been met throughout the appeal period. REMANDED ISSUE At the October 2018 hearing, the Veteran’s daughter testified that the Veteran’s memory impairment and impairment of thought processes causes him to be unable to care for himself. To the extent that the evidence suggests that the Veteran needs assistance with daily living due to his service-connected PTSD symptoms, the issue of entitlement to SMC based on the need for the aid and attendance of another person has been raised, and thus is part of the appeal. Akles v. Derwinski, 1 Vet. App. 118, 121 (1991) (observing that entitlement to SMC is an “inferred issue” in the context of an increased rating claim); Bradley v. Peake, 22 Vet. App. 280 (2008) (finding that SMC “benefits are to be accorded when a Veteran becomes eligible without need for a separate claim”); Buie v. Shinseki, 24 Vet. App. 242, 250-51 (2011). Thus, this matter is remanded for development and adjudication. The matter is REMANDED for the following action: 1. Obtain all outstanding VA medical records and ask the Veteran to provide authorizations for any private medical records he would like considered in connection with his appeal. 2. Schedule the Veteran for an appropriate VA examination to address his claim of entitlement to SMC based on the need for aid and attendance of another person. STEVEN D. REISS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Tracie N. Wesner, Counsel