Citation Nr: 18156552 Decision Date: 12/11/18 Archive Date: 12/10/18 DOCKET NO. 13-12 624 DATE: December 11, 2018 ORDER Entitlement to an initial rating of 70 percent for the Veteran’s posttraumatic stress disorder (PTSD) is granted. FINDING OF FACT Throughout the appeal period, the Veteran’s PTSD has most nearly approximated occupational and social impairment with deficiencies in most areas. CONCLUSION OF LAW The criteria for entitlement to a 70 percent rating for posttraumatic stress disorder (PTSD) the entire appeal period have been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. § 4.130, Diagnostic Code 9411 (2018). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active duty service from February 1993 to November 1997 and from April 2001 to February 2008. He testified before the undersigned Veterans Law Judge at a Board videoconference hearing in May 2017. A transcript of the hearing is of record. As previously noted, at his hearing, the Veteran indicated satisfaction with the 70 percent rating assigned for his PTSD, effective January 15, 2016, and limited his appeal to the matter of whether higher ratings are warranted prior to that date. Entitlement to an initial rating higher than 30 percent for posttraumatic stress disorder prior to July 1, 2013; and higher than 50 percent from July 1, 2013, to January 15, 2016. 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. PTSD is rated under 38 C.F.R. § 4.130, Diagnostic Code 9411. The rating criteria provide that a 30 percent rating is warranted for occupational and social impairment with occasional decrease in work efficiency and intermittent periods of 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 (weekly or less often), chronic sleep impairment, mild memory loss (such as forgetting names, directions, recent events). 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 effective work and social relationships. Id. A 70 percent rating 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 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. Id. A 100 percent rating 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. 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. 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. 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 solely on the basis of social impairment. 38 C.F.R. § 4.126. 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 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). When considering all the evidence of record, the Board finds that a 70 percent rating for the Veteran’s PTSD is warranted for the entire appeal period. Prior to July 1, 2013, the evidence shows that the Veteran’s PTSD manifested by symptoms of loss of interest in activities that previously were enjoyable, including social and family activities and being a coach for his son’s soccer team; lack of sleep; irritability; avoidance of crowds; feeling depressed; and impairment of concentration and memory. There were no suicidal ideations, no mania or psychosis; and no panic attacks but the Veteran experienced anxiety when talking about Iraq. In a January 2011 statement, his then-wife reported that he had symptoms of depression, sleep impairment, neglect of hygiene, a negative outlook, was easily angered, hypervigilant, and lacked focus to include forgetting to pay bills, following up on necessary school deadlines, and chores. She also explained that he was unable to play with or interact with his son due to his PTSD. Since July 1, 2013, VA treatment records document symptoms of difficulty with concentration, social isolation, avoidant behavior, anger issues, and an inability to handle stress. They also document that the Veteran essentially would come home from work and go straight to sleep with not much else; he worked alone and was unable to relate to any of his co-workers. At his Board hearing in May 2017, he also reported that when he was in school he could not establish relationships with other students as he felt he could not find a common ground with them. He also reported throughout the appeal period that if it was not for his son “I don’t think I would interact with the world.” At his January 15, 2016, VA examination, which was the basis for the Veteran’s increased rating claim, the examiner specifically stated “vet continues to have active symptoms of PTSD and it has impacted his social life (divorced now) and also affects his other relationships and work. However, PTSD symptoms have not increased since previous rating exam . . . Symptom severity remains the same as previous exam.” Essentially, the evidence shows that throughout the appeal period, the Veteran’s PTSD has caused him to lose interest in almost all enjoyable activities and isolate from almost everyone in his life. He has struggled to focus and often neglected his personal appearance and hygiene due to lack of motivation. He was not able to sustain a marriage and has a poor relationship with his son, whom the Veteran reported is the only person he is able to sustain a relationship with. The Board finds that these symptoms most nearly approximate occupational and social impairment with deficiencies in most areas. To warrant a higher rating total occupational and social impairment must be demonstrated. A higher rating is not warranted at any time during the appeal period as the Veteran continues to work, and although strained, continues to have a relationship with his son. In sum, the evidence shows that the Veteran’s PTSD has generally manifested by the same symptoms throughout the appeal period. His symptoms are of the severity and type to cause occupational and social impairment with deficiencies in most areas such that a 70 percent rating is warranted for the entire appeal period. H.M. WALKER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Martha R. Luboch, Associate Counsel