Citation Nr: 18156555 Decision Date: 12/11/18 Archive Date: 12/10/18 DOCKET NO. 16-59 141 DATE: December 11, 2018 ORDER Entitlement to an initial rating of 70 percent, but not higher, for posttraumatic stress disorder (PTSD) is granted, subject to the law and regulations governing the payment of monetary benefits. FINDING OF FACT The Veteran's PTSD is manifested by symptoms such as obsessional rituals, which interfere with routine activities; 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); difficulty in adapting to stressful circumstances (including work or a work-like setting); and an inability to establish and maintain effective relationships. CONCLUSION OF LAW The criteria for an initial rating of 70 percent, but not higher, for posttraumatic stress disorder (PTSD) have been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.102, 3.321, 4.1, 4.2, 4.3, 4.7, 4.10, 4.130, Diagnostic Code 9411 (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served in the United States Marine Corps with active duty from June 1986 to June 1992, and in the Unites States Army with active duty from October 2003 to February 2004. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 2015 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Winston-Salem, North Carolina, which granted the Veteran's claim for service connection for PTSD and assigned an initial evaluation of 50 percent. In deciding claims, it is the Board's responsibility to evaluate the entire record on appeal. 38 U.S.C. § 7104(a) (2012). Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss each and every piece of evidence submitted by the Veteran or on his behalf. Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). Rather, the Board's analysis below will focus specifically on what evidence is needed to substantiate the claims and what the evidence in the claims file shows, or fails to show, with respect to the claims. Timberlake v. Gober, 14 Vet. App. 122, 128-30 (2000). Entitlement to an initial rating in excess of 50 percent for posttraumatic stress disorder (PTSD) The Veteran has a 50 percent rating for PTSD which is rated under 38 C.F.R. § 4.130, Diagnostic Code 9411. Under 38 C.F.R. § 4.130, Diagnostic Code 9411, a 50 percent evaluation is warranted when 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 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; the Veteran's difficulty in establishing and maintaining effective work and social relationships. A 70 percent disability rating requires 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); or inability to establish and maintain effective relationships. A 100 percent disability rating requires 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 as to time or place; or demonstrated memory loss for names of close relatives, own occupation, or own name. Id. The use of the phrase "such symptoms as," followed by a list of examples, provides guidance as to the severity of symptomatology contemplated for each rating. The use of such terminology permits consideration of items listed and other symptoms and contemplates the effect of those symptoms on the Veteran's social and work situation. Mauerhan v. Principi, 16 Vet. App. 436 (2002). The Board acknowledges that symptoms recited in the criteria in the rating schedule for evaluating mental disorders 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." Id., at 442. In adjudicating a claim for a higher rating, the adjudicator must consider all symptoms of a claimant's service-connected mental condition that affect the level of occupational or social impairment. Id., at 443. Disability ratings are determined by evaluating the extent to which a veteran's service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, including employment, by comparing the symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.10 (2017). The percentage ratings in the Rating Schedule represent the average impairment in earning capacity resulting from service-connected diseases and injuries and their residual conditions in civilian occupations. The percentage ratings are generally adequate to compensate for considerable loss of working time from exacerbation or illness proportionate to the severity of the disability. Diagnostic Codes (DCs) are assigned by the rating officials to individual disabilities. DCs provide rating criteria specific to a particular disability. If two DCs are applicable to the same disability, the DC that allows for the higher disability rating applies. 38 C.F.R. § 4.7 (2017). When a question arises as to which of two ratings apply under a particular DC, the higher evaluation is assigned if the disability more closely approximates the criteria for the higher rating. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of a veteran. 38 C.F.R. § 4.3. In disability rating cases, VA assesses the level of disability from the initial grant of service connection or a year prior to the date of application for an increased rating and determines whether the level of disability warrants the assignment of different disability ratings at different times over the course of the claim, a practice known as "staged ratings." Fenderson v. West, 12 Vet. App. 119, 126 (1999); Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007) (holding that staged ratings may be warranted in increased rating claims). The Veteran asserts that he is entitled to an initial rating in excess of 50 percent for his PTSD. The Veteran was evaluated for his PTSD symptoms by a VA examiner in September 2014. During that examination, the Veteran was diagnosed with PTSD. The examiner determined that the Veteran had occupational and social impairment due to mild or transient symptoms which decrease work efficiency and ability to perform occupational tasks only during periods of significant stress, or; symptoms controlled by medication. The Veteran reported symptoms such as feeling of detachment from others, markedly diminished interest or participation in significant activities, feeling of detachment from others, difficulty sleeping, distressing dreams related to a traumatic event, hypervigilance, anxiety, and suspiciousness. The examiner explained that the 50 percent evaluation was appropriate and attributed to the Veteran’s diagnosis of PTSD. The Veteran’s private physician submitted an evaluation in March 2014 to summarize and explain the impact the Veteran’s PTSD has on his daily life. The evaluation explained that the Veteran has problems falling asleep and staying asleep and experiences distressing nightmares; experiences extreme hyper-alertness or hypervigilance and anxiety; exhibits irritability or outburst of anger; and experiences mood swings. In addition, the Veteran’s occupational and social impairments are also recorded in a subsequent November 2015 private medical evaluation. This examination confirmed the Veteran's diagnosis of PTSD. During that examination, it was determined that the symptoms were a major impairment with several areas of occupational and social functioning. The evaluation revealed increased social isolation, markedly diminished interest or participation in significant activities, feeling of detachment from others, restricted range of affect, emotionally numb, inability to express feelings to those close to him, difficulty sleeping, disturbing memories and dreams, reliving traumatic events, difficulty concentrating, being generally guarded, sadness or depression, agitation, moody or irritability, decreased desire, and concerns that his life will be “cut short.” In addition, while the Veteran denied any suicidal ideation, the evaluation also shows that the Veteran has impairments in generally trusting people which includes friends and relatives, he is constantly alert due to being overwhelmed with fear and anxiety, and does not feel safe without his weapon, feeling a need to check the perimeter of his house on a constant basis. The Board finds that the examinations in the record are probative and should be considered competent evidence of record. All of the examinations reflect similar symptoms; however, the Board finds that the March 2014 and November 2015 evaluations from the Veteran’s private physician present more detail regarding the Veteran’s documented symptoms, and therefore should be accorded more evidentiary weight. The Board finds evidence in support of a finding that the Veteran's disability picture for PTSD more nearly approximates an 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 that 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 worklike setting); inability to establish and maintain effective relationships. The Veteran’s occupational and social impairment is therefore found to be consistent with a 70 percent disability rating. However, the Board does not find that a preponderance of the evidence is in support of a finding that the Veteran's PTSD symptoms more nearly approximate total occupational and social impairment. First, there is no evidence of record that the Veteran suffered from symptoms such as 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. Moreover, the Veteran has not contended on appeal that he suffers from such symptoms. As noted above, while the Veteran is noted to have occupational and social impairments, such impairments do not rise to the level of total occupational and social impairment. Accordingly, for all the foregoing reasons, the Board finds that the Veteran is entitled to an initial rating of 70 percent, but not greater, for his PTSD. 38 U.S.C. § 5107 (2012). Michael J. Skaltsounis Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. R. Montalvo, Associate Counsel